Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication

J Emerg Med. 2020 Apr;58(4):581-593. doi: 10.1016/j.jemermed.2019.10.035. Epub 2020 Mar 5.

Abstract

Background: The current state of scientific knowledge regarding communication between emergency medicine (EM) providers indicates that communication is critical to safe and effective patient care.

Objectives: In this study, we identified communication needs of EM nurses and physicians; in particular, what information should be conveyed, when, how, and to whom.

Methods: Five semi-structured focus groups and one interview were conducted with nine nurses, eight attending physicians, and four residents. Questions addressed how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share. Sessions were audio recorded. Transcripts were generated and analyzed using a concept mapping approach (a visual qualitative analysis technique to represent and convey synthesized knowledge).

Results: Eleven concept maps were produced summarizing: information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication.

Conclusions: Our main finding of this research is that communication ensures shared awareness of patient health status, the care plan, status of plan steps and orders, and, especially, any critical changes or "surprises" regarding the health of a patient. Additionally, the research identified shared information needs; communication methods, strategies and barriers; and factors affecting successful communication, and has implications for both system and training design. Key implications for emergency nursing practice from this research are distilled in 10 'best practice' strategies for improving EM nurse-physician communication.

Keywords: communication methods; communication strategies; concept maps; information needs; nurse–physician communication; shared awareness.