CJEM Articles: communication
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Understanding communication between emergency and consulting physicians: a qualitative study that describes and defines the essential elements of the emergency department consultation-referral process for the junior learnerJanuary 2013 15 1Donika Orlich, Jonathan Sherbino, Kulamakan Kulasegaram, Teresa Chan
To define the important elements of an emergency department (ED) consultation request and to develop a simple model of the process.
From March to September 2010, 61 physicians (21 emergency medicine [EM], 20 general surgery [GS], 20 internal medicine [IM]; 31 residents, 30 attending staff) were questioned about how junior learners should be taught about ED consultation. Two investigators independently reviewed focus group and interview transcripts using grounded theory to generate an index of themes until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. All transcripts were coded using this index of themes; 30% of transcripts were coded in duplicate to determine the agreement.
A total of 245 themes and subthemes were identified. The agreement between reviewers was 77%. Important themes in the process were as follows: initial preparation and review of investigations by EM physician (overall endorsement 87% [range 70–100% in different groups]); identification of involved parties (patient and involved physicians) (100%); hypothesis of patient's diagnosis (75% [range 62–83%]) or question for the consulting physician (70% [range 55–95%]); urgency (100%) and stability (74% [range 62–80%]); questions from the consultant (100%); discussion/communication (98% [range 95–100%]); and feedback (98% [range 95–100%]). These components were reorganized into a simple framework (PIQUED). Each clinical specialty significantly contributed to the model (χ2 = 7.9; p value = 0.019). Each group contributed uniquely to the final list of important elements (percent contributions: EM, 57%; GS, 41%; IM, 64%).
We define important elements of an ED consultation with input from emergency and consulting physicians. We propose a model that organizes these elements into a simple framework (PIQUED) that may be valuable for junior learners.
Allan S. Detsky, Alun D. Ackery, Jeremy W. Adams, Steven C. Brooks
Denise Watt, Gordon Brannan, William Wertzler
Objectives: To explore the public's expectations of emergency department care and to compare these with emergency department staff perceptions of patient expectations.
Methods: Focus groups were conducted with the residents of Calgary, Alta., and with emergency department staff in the Calgary Health Region. Both recent users of the emergency department and people who had not used the emergency department in the past 3 years were included in this study. An experienced moderator conducted the focus groups, which were taped and then transcribed. A well established method of qualitative analysis identified common themes.
Results: The focus groups identified common expectations of emergency department care. Public expectations were categorized into 6 thematic areas: staff communication with patients, appropriate waiting times, the triage process, information management, quality of care, and improvements to existing services. Those who had recently used the emergency department had similar expectations to those who had not. Emergency department care providers understand some, but not all, of the public's expectations.
Conclusions: Public expectations of emergency department care were identified by this study. The findings are important for quality improvement initiatives and were used to develop a quantitative questionnaire.