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Improving Communication in the Emergency Room

While communication is extremely important in every healthcare environment, the Emergency Room stands out as one where communication success is critical, especially when saving lives can be a matter of quick decisions and responses within minutes or hours. An article in The Journal of Emergency Medicine observes that “Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice” (Amaniyan, 2019).

Poor ED Communication Is a Problem for Providers and Patients

When researching literature about patient safety incidents, the authors above found that poor ED communication played a significant role in unfortunate patient outcomes. Communication lapses on the part of healthcare providers were an identified problem. According to Amaniyan, “Inadequate and poor staff communication were stated as a well-recognized safety challenge that was even more evident in EDs. Problems with the transfer of medical information and orders were considered an important communication-based factor that impacted patient safety. For example, failing to communicate changes in vital signs to the attending physician was an important factor for staff-related communication incidents in EDs” (Amaniyan et al, 2019). In some case , treatment for patients was delayed due to communication failure at the time of handoff between shifts. Additionally, medication management issues such as wrong doses, incorrect medicines, delayed or missing doses, and miscalculations were also attributable to communication problems. Further challenges included lack of compliance with patient safety protocols, such as infection control, clerical or laboratory processes, and incomplete discharge instructions were emphasized in the literature (Amaniyan, 2019).

ED Communication Improvement Strategies

An article about improving ED outcomes focused significantly on the noise problem in emergency departments (Welch et al, 2015) and how it can inhibit successful communication. Some strategies to overcome it include:

  1. Reducing Ambient Noise – Successful ERs have used noise monitors to gauge their noise levels and then pursued strategies to reduce it, from changing out garbage can lids to lowering the decibel level of equipment alarms. When possible, some EDs use single person rooms, which have been found to be quieter. Extra sound absorbing materials may be used, and other noise sources are addressed as necessary.
  2. Use a Communication Scheme – Deliberate communication plans involve a hierarchy of communication. Limiting overhead paging is one option. An urgency-based communication plan can also be effective. Automated paging for consults also can contribute to better and more efficient communication.
  3. Understand Different Approaches to Communication based on roles -- Acknowledge the respective differing communication needs of physicians, nurses, and staff and tailor communication to them.
  4. Reduce the impact of fractured attention spans -- Limit interruptions wherever possible.

Focus on ED Teambuilding to Promote Communication

An article about improving ED Outcomes offers that “Provider organizations with great teams are more effective in improving quality and reducing costs. According to the Joint Commission, communication failure is one of the most-frequently identified root causes of reported sentinel events.” An important strategy to strengthen the ED team is to emphasize “teamwork and communication to create better experiences for patients and staff” (Sharma et al, 2017). In addition, it is a good idea to employ communication tools and methods to share important departmental information, as well as gather feedback from frontline staff. Consider implementing a daily interdisciplinary ED huddle, a worthwhile message of the week, and even creating a virtual suggestion box.

References

Amaniyan, S., et al, “Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review,” The Journal of Emergency Medicine, 13 December 2019, Retrieved at https://www.sciencedirect.com/science/article/pii/S0736467919310121.

Sharma, R., et al, “How One Urban Emergency Department Is Making Care Better,” American Association for Physician Leadership News, October 30, 2017, Retrieved at https://www.physicianleaders.org/news/field-report-how-an-urban-emergency-department-is-making-care-better.

Welch, S., et al, “Strategies for Improving Communication in the Emergency Department: Mediums and Messages in a Noisy Environment,” The Joint Commission Journal on Quality and Patient Safety, June 2013, Retrieved at https://www.edbenchmarking.org/assets/docs/hottopics/welch%20communication%20and%20noise%20in%20%20%20%20the%20ed.pdf.

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