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