Maria Herke

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

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.

The Context of Communication in Emergency Departments

The way we use language is always shaped by and reflects the context in which we are communicating. The communicative challenges and risks in emergency departments arise directly from the unique contextual demands of the emergency department environment. In this chapter, we begin our account of the communication demands of the emergency department by describing the characteristics and context of the emergency department, and how these directly affect the nature of communication.

Public discourse syndrome: Reformulating for clarity

Abstract The purpose of this article is to provide insights into the processes of public discourse and how information can be reformulated for public consumption. The article draws on data from readability research of public information documents conducted in Australia. Public information documents need to be understood by members of the public and a lexicogrammatical analysis, centred on a Theme and Rheme analysis, provides a platform through which readability, or a text’s coherence, can be further examined. The readability data combined with text analyses demonstrate readers’ preferences for clearer Theme structures and coherent development of information within the Rheme. The analysis highlights the functional differences between a text-section judged as difficult-to-read and a text-section preferred by the reader-participants, providing insights into the requirements for achieving clearer public discourse.

The Patient’s Journey in the Emergency Department from Triage to Disposition

Two main priorities guide emergency department care. The first is to determine a patient’s diagnosis . The second is to determine whether that patient can be safely treated within the emergency department and discharged home, or whether they need to be admitted for further treatment and supervision in another hospital ward or health-care facility. From the moment patients arrive at the emergency department to the point of their disposition, their care becomes organised systematically into a series of activities (what we refer to as ‘activity stages’—derived from Engestrom’s 2008 work on systems), each with their own short-term clinical goals, sequentially driven to achieve these outcomes.

Effective Clinician–Patient Communication: Strategies for Communicating Medical Knowledge

Our analysis of how clinicians and patients spoke, listened, and responded to one another in emergency department interactions shows that two broad areas of communication affect the quality and safety of the patient journey through the emergency department:

Effective Clinician–Patient Communication: Strategies for Bridging the Interpersonal Gap

In this chapter, we summarize and exemplify the strategies clinicians can use for establishing and developing a relationship with the patient, and give examples. This process involves the patients in their own care. Both the informational (Chap. 5) and interpersonal communication strategies occur simultaneously, but for the sake of description they are highlighted separately. In both Chaps. 5 and 6, we provide examples of each of the strategies, taken from the authentic extracts.

Communication Risk in Clinician–Patient Consultations

In this chapter, we start our detailed description of the language used in the interactions, focusing in particular on the medical consultations—the last two activity stages of the patient’s journey. Through a detailed description of the actual interactions, we explore how particular ways of communicating with the patient could jeopardise the quality and safety of the patient experience. By showing examples of actual transcripts we demonstrate the link between communication and the quality and safety of the patient experience. We highlight moments of communicative risk—points in the interactions where misalignment or misunderstandings occur.

Action Strategies for Implementing Change

In this book, we have described how organizational and clinician practices and roles in emergency departments manifest in particular communication patterns and interactive styles between clinicians and patients. The central figure throughout the book is the patient, and the central question we have asked is: “How does communication in emergency departments affect both the quality and safety of the patient experience?”

The Role of Communication in Safe and Effective Health Care

In this book, we describe the communicative complexity and intensity of work in emergency departments, and against this backdrop, identify and describe the features of patient–clinician interactions most likely to lead to patient involvement, patient satisfaction, and positive health outcomes. We also detail the communication practices that restrict patient involvement and are susceptible to misunderstandings and breakdowns in communication, which in turn affect patient satisfaction and safety. We then identify ways in which clinicians can enhance their communicative skills to improve the quality and safety of the patient journey through the emergency department. We describe the strategies clinicians use, needed to simultaneously communicate medical knowledge while building rapport and empathy with the patient. We argue that to deliver care effectively, clinicians must communicate care effectively.