Examining Emergency Department Communication Through a Staff-Based Participatory Research Method: Identifying Barriers and Solutions to Meaningful Change

• Published in: Annals of emergency medicine Vol. 56; no. 6; pp. 614 - 622
• Main Authors: Cameron, Kenzie A., PhD, MPH, Engel, Kirsten G., MD, McCarthy, Danielle M., MD, Buckley, Barbara A., RN, Mercer Kollar, Laura Min, MA, Donlan, Sarah M., MD, Pang, Peter S., MD, Makoul, Gregory, PhD, Tanabe, Paula, PhD, MPH, RN, Gisondi, Michael A., MD, Adams, James G., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2010; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Communication; Communication Barriers; Emergency; Emergency and intensive care: techniques, logistics; Emergency Nursing - manpower; Emergency Service, Hospital - manpower; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - standards; Female; Health Services Research - methods; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Interdisciplinary Communication; Internship and Residency - manpower; Male; Medical Errors - prevention & control; Medical sciences; Medical Secretaries; Medical Staff, Hospital; Middle Aged; Patient Care Team - organization & administration; Physician-Patient Relations; Young Adult; Intensive care; Barrier; Emergency department; Resuscitation
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2010.03.017

Study objective We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED). Methods ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop was offered 6 times and involved: (1) large group discussion to review the importance of communication within the ED and discuss findings from a recent survey of patient perceptions of ED-team communication; (2) small group discussions eliciting staff perceptions of communication barriers and best practices/strategies to address these challenges; and (3) large group discussions sharing and refining emergent themes and suggested strategies. Three coders analyzed summaries from group discussions by using latent content and constant comparative analysis to identify focal themes. Results A total of 127 staff members, including attending physicians, residents, nurses, ED assistants, and secretaries, participated in the workshop (overall participation rate 59.6%; range 46.7% to 73.3% by staff type). Coders identified a framework of 4 themes describing barriers and proposed interventions: (1) greeting and initial interaction, (2) setting realistic expectations, (3) team communication and respect, and (4) information provision and delivery. The majority of participants (81.4%) reported that their participation would cause them to make changes in their clinical practice. Conclusion Involving staff in discussing barriers and facilitators to communication within the ED can result in a meaningful process of empowerment, as well as the identification of feasible strategies and solutions at both the individual and system levels.