Emergency Department Communication Links and Patterns

Study objective: We characterize and describe the communication links and patterns between and within emergency department (ED) practitioner types. Methods: This is a prospective, observational study of emergency physician and nursing staff communication patterns in an academic ED using link analysis techniques. Twenty ED staff members were observed in the pediatric and adult acute areas of the ED, including attending physicians, residents, nurses, and charge nurses. Data were recorded for each communication event, including duration, mode, partner, location, and interruptions. Because this study was intended to focus on professionally related communication between staff, social interactions and direct patient interactions were excluded. Frequency percentage and duration were calculated for each measure, and link analysis graphs were prepared to assist in interpretation of the data. Results: One thousand six hundred sixty-five total communication events were recorded during a total of 39 hours 12 minutes of observation. Face-to-face communication was the most common mode. Communication links and patterns were described and graphically represented using a link analysis technique. Communication gaps were found between ambulance providers and the providers who would ultimately take care of the patient during their ED stay. Attending physicians communicated often despite caring for separate patients, and the charge nurse seemed to be the hub for communication, linking ED personnel with non-ED staff. In the adult area, interruption rates ranged from 6.9 per hour (attending physician) to 0.5 per hour (bedside nurse), and in the pediatric area they ranged from 3.6 per hour (attending physician) to 0.3 (bedside nurse). Conclusion: Distinct patterns are identified. These results will be helpful in designing future communication adjuncts in the ED.