Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication.

BACKGROUND: The current state of scientific knowledge regarding communication between emergency medicine (EM) providers indicates that communication is critical to safe and effective patient care. OBJECTIVES: In this study, we identified communication needs of EM nurses and physicians; in particular, what information should be conveyed, when, how, and to whom. METHODS: Five semi-structured focus groups and one interview were conducted with nine nurses, eight attending physicians, and four residents. Questions addressed how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share. Sessions were audio recorded. Transcripts were generated and analyzed using a concept mapping approach (a visual qualitative analysis technique to represent and convey synthesized knowledge). RESULTS: Eleven concept maps were produced summarizing: information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication. CONCLUSIONS: Our main finding of this research is that communication ensures shared awareness of patient health status, the care plan, status of plan steps and orders, and, especially, any critical changes or "surprises" regarding the health of a patient. Additionally, the research identified shared information needs; communication methods, strategies and barriers; and factors affecting successful communication, and has implications for both system and training design. Key implications for emergency nursing practice from this research are distilled in 10 'best practice' strategies for improving EM nurse-physician communication.

Communication in the Electronic Age: an Analysis of Face-to-Face Physician-Nurse Communication in the Emergency Department.

We describe the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. Emergency medicine physicians and nurses were observed for 2 h periods. Researchers used paper notes to document the characteristics (e.g., partners involved, location of communication, who initiated communication) and content of nurse to physician conversations. Eighteen emergency nurses and physicians (nine each) were observed for a total of 36 h. Two hundred and fifty-five unique communication events were recorded across three emergency departments spread evenly across day, evening, and night shifts. A qualitative analysis of communication event content revealed 5 types of communication and 13 content themes. Content themes covered a broad range of topics including exchange of patient health information, management of the ED, and coordination of orders. Physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas. This study describes nature of verbal nurse to physician communication in the ED. Direct communication is still used to communicate important information, such as information about patients' status, in EDs with established electronic health records. Our results provide an overview of information exchanged in the ED which can serve as a basis for designing improved information support systems.