Communication in Emergency Medicine: Implications for Patient Safety1

Abstract

Emergency medicine is largely a communicative activity, and medical mishaps that occur in this context are too often the result of vulnerable communication processes. In this year-long qualitative study of two academic emergency departments, an interdisciplinary research team identified four such processes: triage, testing and evaluation, handoffs, and admitting. In each case, we found that narrative rationality (the patient's story) was consistently subjugated to technical rationality (actionable lists). Process changes are proposed to encourage caregivers to either reconsider their course of action or request additional contextual information. A heightened awareness of the bias for technical over narrative rationality and a better recognition of uncertainty in emergency medicine communication are important first steps toward anticipating potential failures and ensuring patient safety.

Keywords:

• Health Communication
• Patient Safety
• Emergency Medicine
• Handoffs
• Qualitative Methods

Notes

This study was funded by a generous grant from the National Patient Safety Foundation.

1. Typically, the emergency department physician team consists of several doctors in training at various stages who are called interns (if they are in their first postgraduate year out of medical school), or residents (postgraduate years after year 1), supervised by one or more attending physicians (faculty who have completed a full course of postgraduate training and are board certified in emergency medicine). Most of the interns and residents are training in emergency medicine but some may be training in other specialties including internal medicine, surgery, and orthopedics.

2. For example, patients who were HIV positive were referred to in both locations as R.W. or Ryan White; intoxicated patients were never characterized as “drunk” but were instead marked with the symbol ETOH (alcohol).

3. There is some initial evidence that this dynamic applies globally, and not just in North America (M. Woloshynowych & C. Tighe, personal communication, 2005).

4. This finding mainly applies to teaching hospitals; community hospitals are more inclined to admit a broader range of insured patients as a source of revenue.

Additional information

Notes on contributors

Eric M. Eisenberg

Eric M. Eisenberg (Ph.D., Michigan State University) is Professor and Chair of the Department of Communication at the University of South Florida

Alexandra G. Murphy

Alexandra Murphy (Ph.D., University of South Florida) is Associate Professor of Communication at DePaul University

Kathleen Sutcliffe

Kathleen Sutcliffe (Ph.D., University of Texas at Austin) is Professor of Management at the University of Michigan

Robert Wears

Robert Wears (M.D., Johns Hopkins University, M.S., FACEP) is Professor of Emergency Medicine

Stephen Schenkel

Stephen Schenkel (M.D., M.P.P., Harvard University) is Assistant Professor of Emergency Medicine at the University of Maryland Medical Center in Baltimore, Maryland

Shawna Perry

Shawna Perry (M.D., Case Western University) is Assistant Chair and Associate Professor of Emergency Medicine

Mary Vanderhoef

Mary Vanderhoef (M.S.N., ARNP, University of Florida) is a nurse at the University of Florida Health Center in Jacksonville, Florida