Communication in the Emergency Department

AED will be holding a workshop on communication (including scenarios with an actor) on Tuesday 7 May, 4pm-6pm.

Effective communication in the ED setting is critical to providing and safe and appropriate patient care. This includes communication between different healthcare providers, as well as communication between healthcare providers and patients. For any patient in ED, there are multiple episodes where effective communication is required. One study identified 19 separate communication instances required for a single patient to be admitted to hospital from ED. 8312-0057

Unfortunately there are multiple barriers to effective communication in the ED setting. The uncontrolled nature of ED presentations coupled with resourcing issues leads to a lack of time available for clinicians to spend with patients, as well as multiple interruptions to both patient consultations and communication with other healthcare providers. Alcohol, drug, and mental health issues impair communication with patients, as do language problems and stressors associated with illness of injury.

Within emergency department literature there is a clear association between difficult clinician/patient communication and complaints and adverse events. An Australian study published in 2002 analysed complaints received by 36 Victorian EDs over a 61 month period. They found that:

  • the highest complaint rates were associated with patients who were female, born in non-English speaking countries, and were very young or very old
  • over half of complaints were made or written by someone other than the patient
  • the proportion of complaints regarding poor communication (staff attitude, discourtesy, rudeness) was the same (about one third of all complaints) as those relating to improper patient treatment
  • 11% of complaints related to delay in diagnosis or treatment

The authors of the study concluded that both research and focused staff training in communication for the ED setting are necessary. Other studies also highlight the need for communication training in ED. A UK study published in 2000 observed ED SHOs communicating with patients, and found several common weaknesses, namely the use of closed questions and poor negotiation of treatment plan and follow-up. The authors concluded that video-recorded consultations with group feedback may be an effective communication teaching tool. Getting a doctor to listen

Interventions to improve communication between clinicians and patients have been studied in the ED setting, and have been shown to improve patient satisfaction. An Australian study published in 2006 examined the effect of a multi-faceted intervention (communication workshops, a patient education film, and a patient liaison nurse) on patient satisfaction regarding their ED visit. Significant differences were demonstrated in patients’ perceptions of overall ED care, the ED facility itself, feeling ‘cared about as a person’, and feeling ‘informed’ about delays. In the post-intervention period there was a 22.5% reduction in the number of complaints received.

A variety of techniques and mental models have been proposed to improve communication between healthcare providers and their patients. A group from The Bayer Institute For Healthcare Communication created a workshop for ED clinicians and Hospitalists, which is described in the paper Strangers In Crisis: Communication Skills For The Emergency Department Clinician And Hospitalist. They conceived the ‘4E’ model:

  • Engage
  • Empathise
  • Educate
  • Enlist

When combined with ‘opening’ and ‘closing’ communication tasks of a consultation, and the clinical tasks of diagnostic reasoning and treatment planning, the 4 Es contribute to a complete model of clinical care:

A 'complete' model of ED care

A ‘complete’ model of ED care

A literature review published in 2004 identified 5 communication strategies that, when employed in an ED consultation, could enhance its therapeutic potential:

  • asking open questions
  • listening and noticing non-verbal behaviour
  • communicating empathy
  • establishing and addressing concerns
  • agreeing plans

The authors of this review refer to these as ‘therapeutic communication techniques’, which are described in more detail in the three slides below. These slides are from a nursing syllabus, but are equally relevant to ED doctors (use the ‘enlarge’ button bottom-right)


Additional full-text references for this post (these links will only work from an ADHB computer)

Identifying vulnerabilities in communication in the emergency department 

Better communication in the emergency department

Complaints from emergency department patients largely result from treatment and communication problems

A multifaceted intervention improves patient satisfaction and perception of emergency department care

Communication skills training for emergency department senior house officers – a qualitative study

Ultrasound at Adult Emergency Department, Auckland City Hospital

By Dr Owen Doran, ED Specialist, Auckland AED Ultrasound Lead


Philips Sparq

We currently have two ultrasound machines in our department- an older Envisor (Philips) and our new machine, the Sparq (also a Philips machine). We were the first emergency department in Australasia to own the Sparq, and it has been put to good use – its size, manoeuvrability and ease of use have made it popular. The image quality is also an improvement on our older machine.

Positive FAST scan

Positive FAST scan

Being a major trauma centre, the main use of ultrasound in the department is FAST and EFAST in the resuscitation room.  This has allowed timely assessment for free intra peritoneal blood in our unstable trauma patients, supporting decisions regarding further management.

We also perform a number of screening scans for AAAs- particularly in older (>50yo) patients with undifferentiated abdominal pain. This has in the past, and will likely in the future been lifesaving.

The third biggest area of use has been procedural ultrasound- particularly for vascular access. As well as using ultrasound for safe central venous access, we are increasing using ultrasound for difficult peripheral access. This certainly saves time and patient discomfort. With the recent purchase of a peripheral and internal jugular phantom, we will be able to improve our teaching of these vital skills.

The next application where I think ultrasound will benefit our patients will be in patients with shock. There are a number of protocols (e.g. RUSH) that have been shown to be beneficial to patients whose shock is poorly differentiated- aiding diagnosis and guiding management. This is an area that I hope we will develop our skills as a group.

Our challenges in the near future include improving our accreditation for our senior doctors, and also developing ultrasound skills amongst our trainees.

Click here for information and documentation regarding accreditation

Click here for a list of web-based ultrasound resources 

Emergency Ultrasound Web Resources

By Dr Owen Doran, ED Specialist, Auckland AED Ultrasound Lead 


Essentially an online textbook of Emergency Medicine Ultrasound from ACEP- very well laid out, great graphics, and a relatively easy read.

Life in the Fast Lane

This is a great round up of ultrasound resource from the crew at LITFL- my favourite EM site.


These downloadable videos are provided free from CME download. A little dated looking, they are from some of the leading lights in Emergency Department ultrasound, and are well worth a look.

Ultrasound Podcast

An excellent resource from passionate ED sonographers.


This is a fantastic website from the Hennepin County Medical Centre- there are a few great ultrasound videos, as well as other useful clips.


An organisation dedicated to bringing critical care and emergency ultrasound to the world. If you get a chance to attend one of their conferences- jump at it!


For members of the ACEM, there is an ultrasound module as part of the e-learning. This comprises of online lectures, and images for review, with an Australasian bent.

The college website also has guidelines and policies related to ultrasound use in Australasian emergency departments.


The Australasian Society for Ultrasound in Medicine is the peak body for promoting ultrasound in Australasia. As well as education, they are responsible for policy regarding ultrasound, and the promotion of ultrasound in the region.



Some useful education packages on this website.


Some useful resources on the Phillips website.

Courses/ Training  ( see also ASUM)

Australian Institute of Ultrasound

The team at the AIU on the Gold Coast run a range of courses for those interested in Emergency Ultrasound , catering for different levels of training, and also for those wanting more subspecialty areas ( like MSK and ECHO).

Ultrasound Training Solutions

Another popular ultrasound training company.

University of Otago

This is a great course that I completed last year- a one year certificate with an excellent faculty and a great way to hone your skills.

Wellington Ultrasound

This first department in NZ to have their own director of Emergency Ultrasound. They also run courses, so that we don’t have to leave good ole NZ for our sonography training!