Emergency communication: the discursive challenges facing emergency clinicians and patients in hospital emergency departments

Abstract

Effective communication and interpersonal skills have long been recognized as fundamental to the delivery of quality health care. However, there is mounting evidence that the pressures of communication in high stress work areas such as hospital emergency departments (EDs) present particular challenges to the delivery of quality care. A recent report on incident management in the Australian health care system (NSW Health, 2005a) cites the main cause of critical incidents (that is, adverse events such as an incorrect procedure leading to patient harm), as being poor and inadequate communication between clinicians and patients. This article presents research that describes and analyses spoken interactions between health care practitioners and patients in one ED of a large, public teaching hospital in Sydney, Australia. The research aimed to address the challenges and critical incidents caused by breakdowns in communication that occur between health practitioners and patients and by refining and extending knowledge of discourse structures, to identify ways in which health care practitioners can enhance their communicative practices thereby improving the quality of the patient journey through the ED. The research used a qualitative ethnographic approach combined with discourse analysis of audio-recorded interactions. Some key findings from the analysis of data are outlined including how the absence of information about processes, the pressure of time within the ED, divergent goals of clinicians and patients, the delivery of diagnoses and professional roles impact on patient experiences. Finally, the article presents an in-depth linguistic analysis on interpersonal and experiential patterns in the discursive practices of patients, nurses and doctors.

Action Strategies for Implementing Change

“…Communicating in the emergency department will always involve a combination of spoken and written exchanges, with the role of written documentation playing a significant role from both a medicolegal and a clinical perspective (Eisenberg et al 2005;Hobbs 2007;Slade et al 2008). Although our study focused on spoken language in emergency departments, our data indicated that patients' written records were a potential source of miscommunication and risk.…”

Bruk av skjønn for å styrke informasjon og frivillighet

“…Forståelse kan like mye vaere et spørsmål om erfaring, mening, innlevelse og vilje til deltakelse. Med en rent intellektualistisk tilnaerming er det vanskelig å akseptere at en del deltakere i forskning samtykker uten å ha lest informasjonsskriv (se for eksempel Høyer 2003), eller at pasienter samtykker uten å ha forstått: «Jeg hørte hva legen sa, men jeg forsto ikke hva hun sa» (Slade et al 2008, min oversettelse). Men hvis man legger til grunn at forståelse kanskje i enda større grad dreier seg om erfaringen av tillit eller oppfattelsen av måten man blir møtt på, er slike samtykker på et vis like «gyldige» etisk sett.…”

Register in the round: registerial cartography

“…One focus in our own healthcare communication research, in both Australia and Hong Kong, has been on communication in emergency (or accident and emergency) departments in large hospitals (for the foundational EDCOM project, see Slade et al 2008;Slade et al 2011). From the point of view of the patient who enters an emergency department, the organizing principle of their visit will be their "journey" through the department, from triage to admission to a hospital ward or, hopefully, discharge.…”