the ineffective communication in hospital emergency departments (monday)

7/31/2019 The Ineffective Communication in Hospital Emergency Departments (Monday)

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ABSTRACT :

has been identifiedasthe major cause of critical incidents in public

hospitals in Australia. (Background) areadverse events leading to

avoidable patient harm. (Background) discussesa study thatfocused on

spoken interactions between clinicians andpatients in the emergency department of a large,public teaching hospital in New South Wales,Australia. (Purpose)


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wastoidentify successful andunsuccessful communication encounters. (Purpose)

combinedtwo complementary modes of analysis:qualitative ethnographic analysis of the social practicesof emergency department healthcare and discourse

analysis of the talk between clinicians and patients.(Method)

allowedthe researchers to analyse how talkissocially organisedaround healthcare practices and howlanguage and other factorsimpactonthe effectiveness ofcommunication. (Method)


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constructsparticular

challenges for effective communication. (Result)

The article analyses patientclinician interactions

within the organizational and professional practices ofthe emergency department andhighlights some systemic

and communication issues. (Result)

Itconcludes with some implications for the professionaldevelopment of clinicians and an outline of ongoing

research in emergency departments. (Findings)


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have long been recognizedas fundamental to thedelivery of quality healthcare. (background)

However, that the

pressure of communication in high-stress workareas such as hospital emergency departments

presentparticular challenges for the delivery ofquality care. (background)


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cites

poor & inadequate communication between cliniciansand patients as the main cause of critical incidents.(background)

isparticularly complex, as cliniciansare nowincreasingly expectedto work in teams to treatculturally diverse patients whopresentwith multiple

symptoms and problems. (background)


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isalso the basis formany patientcomplaintsabout the healthcare

system (Taylor, Wolfe and Cameron 2002;NHMRC 2004; Health Care ComplaintsCommission 2005). (background)

In their literature review, demonstratehow failure to recognizetheimportance of language and culturecan resultin arange of health-related issues, including obtaining

informed consent, failure to understand diagnosisand treatment, preventable morbidity andmortality, dissatisfaction with care and lower

quality care in general. (background)


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are perceivedto be due, to a

large extent, to the numbers of practitioners and

patients who are not proficient in English (Floreset al 2002). (background)

Currently, are

from language backgrounds other than English,and the hospital in this study had a total of 25%

overseas-trained doctors whohadEnglish as asecond language. (background)


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However, has showna significant number

of clinician

patient communication difficulties andbreakdownsarebetween people whobelievetheyare communicating satisfactorily in English.(background)

hasdemonstratedthat serious communication problems

can occurwhere thereis noevident languagebarrier, and where itis assumedthat thereisashared language. (background)


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For example,can occurbecause of

different cultural assumptions about howtostructureinformation or an argument inconversation, howto signalconnections and logic,or howto indicatethe significance of what is being

said in terms of overall meaning and attitude.(background)

, such as tone of voice

and intonation patterns, can resultin inaccurateinferences being drawn about knowledge, attitudeor behaviour (Gumperz, Jupp and Roberts 1991).(background)


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For a number of decades now,have

been carried outusing either linguistic ororganizational approaches (Wodak 2006).(background)

using a numberof case histories, showedthe advantage of aconversation-analytical approach. (background)

have focusedon healthcarecommunication in general (Sarangi and Roberts1999; Candlin 2000; Coiera et al 2002; Cordella 2004;Iedema 2005, 2006; Wodak 2006; Sarangi in press).

(background)


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However, to date, has been noresearch thatexaminesthe dynamic complexity of interactions

unfolding in real time in high-risk environments suchas emergency departments. (background)

arenow of increasing interest as

social organisations because of the technologically morecomplex medicalised practices of modern healthcareand the interplay of professionals in changingorganisations (Iedema 2007). (background)


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have beena significant number of recent

complaints from patients in relation to theirexperiences in emergency departments in New SouthWales, many involvinginadequate communication.(background)

P are also expressingdissatisfaction(Joseph 2007) and professional disquiet (Bragg-Kingsford 2007). (background)


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citeslack of funding, inadequatestaffing and overdependence on locums for the

difficulties faced in emergency departments(Wallace 2007). (background)

outlinesfindings of a pilot study that

took place in the emergency department of a largeteaching hospital in Sydney, Australia.(background)


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were to: describe,map and analyse the communication encountersthatoccurredbetween clinicians and patients in

the emergency department in order toidentifythe features of both successful and unsuccessfulencounters, identify ways in which clinicianscanenhancetheir communicative practices toimprove the quality of the patient journey

through the emergency department.(purpose)

wascross-disciplinary andinvolvedacademics in applied linguistics and nursing fromthe University of Technology, Sydney, and

Macquarie University, language educators fromthe New South Wales Adult Migrant EnglishService and healthcare professionals from theArea Health Service. (background)


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focused oncommunication betweenclinicians and patients whowere deemedto be able to

communicate effectively in English. (purpose)

werefrom language backgrounds other thanEnglish and English-speaking backgrounds, but patients

whoneededinterpreterswere not included. (method)

believethis study to be unique in that, for the firsttime, patientswere observedandrecordedfrom the

moment theyenteredthe hospital emergencydepartment (triage) to the moment a decision aboutfurther hospital treatment or release from the emergencydepartmentwas made. (method)


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situatedpatient experiences andcommunication exchanges within professional and

institutional practices (Gumperz 1982; Sarangi andRoberts 1999; Iedema 2005; Kemmis in press) of theemergency department, andrelatedthe interactionsbetween patients and clinicians to the broader,

systemic exigencies and the roles and discoursepractices of healthcare professionals, managers andpolicy-makers. (methods)

thuscontributesto discourseknowledge in the context of critical healthcareservices. (purpose)


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beginsby introducing the hospital in

terms of general demographics, followedbyanoutline of the research methods. (method)

presentssome examples of spoken data and

discusses some major findings. (method)

concludeswith implications for the

professional development of clinicians and adescription of ongoing research in a further fourhospitals. (finding)

the ineffective communication in hospital emergency departments (monday)

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