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

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Abstract

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.

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Acknowledgements

This work was supported by the Agency for Healthcare Research and Quality (R01HHS022542) (PI: RJF). Ms. Benda is supported by the National Science Foundation’s graduate research fellowship program (1117218). The authors have no conflicts of interest to report.

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Authors and Affiliations

  1. National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, DC, 20002, USA

    Natalie C. Benda, A. Zachary Hettinger, Daniel J. Hoffman, Akhila Iyer, Ella S. Franklin & Rollin J. Fairbanks

  2. Department of Industrial and Systems Engineering, State University of New York at Buffalo, Buffalo, NY, 14228, USA

    Natalie C. Benda, Ann M. Bisantz, Nicolette M. McGeorge, Rebecca L. Berg & Rollin J. Fairbanks

  3. Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, 20007, USA

    A. Zachary Hettinger & Rollin J. Fairbanks

  4. Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, 21202, USA

    Nicolette M. McGeorge

  5. Roth Cognitive Engineering, Stanford, CA, 94305, USA

    Emilie M. Roth

  6. School of Nursing, The George Washington University, Washington, DC, 20006, USA

    Ella S. Franklin

  7. Department of Emergency Medicine, University of Florida, Jacksonville, FL, 32209, USA

    Shawna J. Perry & Robert L. Wears

  8. Clinical Safety Research Unit, Imperial College of London, SW7 2AZ, London, UK

    Robert L. Wears

Authors
  1. Natalie C. Benda
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  2. A. Zachary Hettinger
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  3. Ann M. Bisantz
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  4. Daniel J. Hoffman
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  5. Nicolette M. McGeorge
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  6. Akhila Iyer
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  7. Rebecca L. Berg
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  8. Emilie M. Roth
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  9. Ella S. Franklin
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  10. Shawna J. Perry
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  11. Robert L. Wears
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  12. Rollin J. Fairbanks
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Corresponding author

Correspondence to Natalie C. Benda.

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Research approval was obtained from the institutional review board for the healthcare system.

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Benda, N.C., Hettinger, A.Z., Bisantz, A.M. et al. Communication in the Electronic Age: an Analysis of Face-to-Face Physician-Nurse Communication in the Emergency Department. J Healthc Inform Res 1, 218–230 (2017). https://doi.org/10.1007/s41666-017-0008-3

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  • DOI: https://doi.org/10.1007/s41666-017-0008-3

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