Emergency Physician and Emergency Nurse Communication in the Emergency Department: A Mixed-methods Study

The emergency department (ED) is a setting where communication occurs often and with potential consequences for patient care. In this study we sought to determine nurse and physician perspectives on the nature and implications of effective and ineffective communication in the ED.

We used a mixed-methods design, including an online survey followed by in-person focus groups with emergency nurses (EN) and emergency physicians (EP). Participants were recruited through email listserves to emergency staff at four hospitals. We integrated quantitative survey results with focus-group themes.

A total of 115 eligible ENs and EPs completed the initial questionnaire (50% response rate from ENs, 65% response rate from EPs). Responses from nurses and physicians were similar; both noted that poor communication is frequent, adversely affects patient care and ED function, affects trust, particularly between individuals, and that non-verbal communication behaviors affect team communication. In the focus groups (consisting of 18 EPs and 17 ENs), six themes emerged: 1) Situations, built physical environment, and medium of communications all impact quality of communication; 2) core elements of desired professional communication include respect and attention, often conveyed through non-verbal behaviors; 3) poor communication begets poor communication and influences interpersonal relationships; 4) effective communication is seen as fundamental to patient care but also has impacts beyond patient care; 5) clinician gender and gender dyads influence communication dynamics; and 6) participants were able to identify learning activities and techniques for effective communication.

Emergency nurses and physicians across four EDs described failures of communication as both frequent and significant to patient care. This study identified characteristics of effective communication, complex factors influencing communication, and emphasized the whole-team impact of communication quality.