Communicating in Hospital Emergency Departments (eBook)

Preface 5
Acknowledgements 8
A Note on Transcription Conventions 10
Contents 11
List of Figures 15
List of Tables 16
Chapter-1 17
The Role of Communication in Safe and Effective Health Care 17
1.1 Introduction 17
1.2 Communication and Patient Safety 19
1.2.1 Patient-Centred Care 21
1.3 Communication in Emergency Departments 22
1.3.1 Research on Patient Experience and Satisfaction 22
1.3.2 Research into Communication Practices in Emergency Departments 25
1.4 Our Qualitative Approach 27
1.4.1 Data Collection 27
1.4.2 Methods 29
1.4.3 Research Sites 31
1.5 Conclusion 34
References 36
Chapter-2 40
The Context of Communication in Emergency Departments 40
2.1 Introduction 40
2.2 Setting the Scene: A Busy Day in an Emergency Department 41
2.3 The Context of the Emergency Department 44
2.3.1 Operational Hours and Uncapped Patient Loads 44
2.3.2 Increased Presentations and Overcrowding in Emergency Departments 45
2.3.3 Short-term, Episodic Patient Care: The Lack of Familiarity Between Emergency Department Patients and Clinicians 47
2.3.4 The Physical Environment: Noise Levels, Privacy and Comfort 47
2.3.5 Multidisciplinary Healthcare Teams 48
2.3.6 Joint Role of Emergency Departments as Training Facilities 49
2.3.7 Time Constraints 50
2.3.8 Face-to-Face Spoken Communication 51
2.3.9 Linguistic and Cultural Diversity 51
2.4 The Communicative Complexity of the Emergency Department 52
2.4.1 Networks of Care 52
2.4.2 Risks to Knowledge/Information Transfer 59
2.4.3 Communication Load 60
2.4.4 Communication Burden 60
2.4.5 Communication Challenges of Multidisciplinary Care 61
2.4.6 The Patient as Outsider: The Importance of Explanations 63
2.4.7 Different Understandings of Time 65
2.5 Conclusion 66
References 68
Chapter-3 70
The Patient’s Journey in the Emergency Department from Triage to Disposition 70
3.1 Introduction 70
3.2 Triage 71
3.2.1 Waiting Room 72
3.2.2 Ambulance Bays 74
3.2.3 Communication in the Triage Stage 75
3.2.4 Communication in the Triage Stage: Summary 76
3.3 Nursing Admission 77
3.3.1 Communication in the Nursing Admission Stage 78
3.3.2 Summary: Communication in Nursing Admission 79
3.4 Medical Consultations 80
3.4.1 Comparative Effectiveness of the Communication Styles of Senior and Junior Doctors 82
3.4.2 Initial Medical Consultation: Greeting, Initial Contact, Exploration of Condition, History-Taking, Diagnostic Tests and Procedures 84
3.4.3 Communication in the Initial Medical Consultation 86
3.4.4 Summary: Communication in the Initial Medical Consultation 87
3.4.5 Final Medical Consultation: Diagnosis, Treatment and Disposition 88
3.4.6 Communication in the Final Medical Consultation Stage 89
3.4.7 Summary: Communication in the Final Medical Consultation 92
3.5 Conclusion 92
Reference 92
Chapter-4 94
Communication Risk in Clinician–Patient Consultations 94
4.1 Introduction 94
4.2 Link Between Communication and Health Outcomes 95
4.3 Potential Risk Points in the Consultation 96
4.3.1 Potential Risk Point: Failure to Track the Patient’s Narrative and Listen to the Patient’s Cues 97
4.3.2 Potential Risk Point: Patient Involvement—Not Listening to the Patient 100
4.3.3 Potential Risk Point: Patient Involvement—Not Informing the Patient 102
4.3.4 Potential Risk Point: Delivery of Diagnosis 102
4.3.5 Communication Breakdowns in Transitions of Care 103
4.4 Systemic Order of Risk 106
4.5 Communication as a Risk Factor in Patient Safety 109
4.6 Conclusion 109
References 110
Chapter-5 112
Effective Clinician–Patient Communication: Strategies for Communicating Medical Knowledge 112
5.1 Introduction 112
5.2 Bridging the Information Gap: Effective Strategies for Developing Shared Medical Knowledge and Decision-Making 113
5.2.1 Make Space for the Patient’s Story 113
5.2.2 Recognise the Patient’s Knowledge and Opinions About Their Condition 122
5.2.3 Explain Medical Concepts in Common-sense Language 125
5.2.4 Spell Out Explicitly Management/Treatment Rationales 126
5.2.5 Provide Clear Instructions for Medication and Other Follow-Up Treatment 130
5.2.6 Signpost the Hospital Process 132
5.2.7 Negotiate Shared Decision-Making About Treatment 134
5.2.8 Repeat, Check and Clarify Throughout 137
5.3 Conclusion 138
Reference 139
Chapter-6 140
Effective Clinician–Patient Communication: Strategies for Bridging the Interpersonal Gap 140
6.1 Introduction 140
6.2 Bridging the Interpersonal Gap—Effective Strategies for Developing Rapport and Empathy with Patients 144
6.2.1 Introduce Yourselves as Clinicians and Explain your Roles 144
6.2.2 Use Inclusive Language 147
6.2.3 Use Colloquial Language and Softening Expressions 149
6.2.4 Give Positive and Supportive Feedback 151
6.2.5 Recognise the Patient’s Perspective 155
6.2.6 Intersperse Medical Talk with Interpersonal Chat 156
6.2.7 Share Laughter and Jokes 157
6.2.8 Demonstrate Intercultural Sensitivity 158
6.3 Conclusion 158
References 160
Chapter-7 161
Action Strategies for Implementing Change 161
7.1 Introduction 161
7.2 Action Strategies 162
7.2.1 Achieve a Balance Between Medical and Interpersonal Communication 162
7.2.2 Provide Explicit Explanations to Patients About Processes and Procedures in the Emergency Department 162
7.2.3 Develop Effective Interdisciplinary Teamwork 164
7.2.4 Develop Cross-Cultural Communication Awareness and Strategies 164
7.2.5 Introduce More Effective and Durable Forms of Patient Records 165
7.2.6 Provide Training with Authentic Materials 166
7.2.7 Examine Communication in Clinical Handovers 166
7.2.8 Examine Continuity of Care from Discharge to the Community 167
7.3 Conclusion 167
References 168
Index 169