MedStar Investigators Identify Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication

Researchers at MedStar Health sought to understand how communication between emergency medicine (EM) providers plays a critical role in delivering safe and effective care to patients. “Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication” led by A. Zachary Hettinger, MD, MS, from the MedStar Health National Center for Human Factors in Healthcare was published in The Journal of Emergency Medicine. This study identified communication needs of emergency medicine nurses and physicians, in particular, what information should be conveyed, by whom and the most appropriate time to convey the information based on the clinical scenario.

The research used semi-structured focus groups and interviews to identify communication strategies and barriers associated with information sharing in emergency medicine. Nine EM nurses, eight EM attending physicians, and four EM resident physicians participated in five focus groups and one interview to address questions regarding 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.

The interview sessions were audio recorded and transcripts were analyzed using a concept mapping approach. Eleven maps were developed to describe the role communication plays in patient outcomes comprised of: categories of 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.

Participants described several communication-enhancing strategies and the research team produced ten strategies to help support effective nurse-physician communication. These strategies include:

  1. Communicate diagnostic assessment, plan of care and, especially, disposition plan to other team members as early as possible. Update the team of any changes to the plan.
  2. Communicate pending tasks/steps in the patient’s care as well as information regarding changes or holdups to tasks or orders.
  3. Communicate details regarding proactive diagnostic testing and therapeutic interventions.
  4. Don’t assume everyone has a shared understanding: recognized that you might have unique access to information and make sure that it is shared in a timely manner.
  5. Notify providers of any critical or unexpected changes in vital signs or patient status.
  6. Do not assume electronic orders substitute for verbal communication
  7. Use asynchronous communication for lower priority items to aid in prioritization.
  8. Adapt communication strategies based on team members’ experience level and existing relationships.
  9. Adapt communication strategies to the physical layout of the ED, especially in those facilities where nurses and physicians may have workstations out of sight from one another or where it is not obvious which staff members are on different care teams
  10. Use strategies that exploit provider experience level regardless of role hierarchy.

The key findings of this study help provide insight on how to improve communication and patient care within the EM department. While the information needed by physicians and nurses was similar, discrepancies in knowledge occurred from timing of when a patient or family member was spoken to; differential access times to the EHR; complexities in information sharing among trainees, nurses, and physicians; or because each role may have had unique opportunities to access information.

This research was supported by the Agency for Healthcare Research and Quality, United States (R01HS022542).

The research team included A. Zachary Hettinger, MD, MS; Natalie Benda, PhD; Daniel Hoffman, BS; Akhila Iyer, MS; Ella Franklin, MSN, RN; R. J. Fairbanks, MD, MS from MedStar Health National Center for Human Factors in Healthcare in collaboration with researchers from Roth Cognitive Engineering; Department of Emergency Medicine, University of Florida, Jacksonville Medical Center; Department of Emergency Medicine, Georgetown University School of Medicine; and the Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York.

The Journal of Emergency Medicine, 2019. DOI: 10.1016/j.jemermed.2019.10.035