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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  11 nurse conducts a physical examination. If necessary, laboratory work and X-rays are ordered. Once test results are received and interpreted, a physician consults with the patient, offering a diagnosis and treatment plan. Finally, the patient is either admitted to the hospital or discharged from the ED. This ideal model makes a number of assumptions about the care process. First, the ED visit is conceived of as linear, with each step regarded as independent and following from another. Second, the arrows between the steps are unidirectional, suggesting that patients always move forward and that there is no backtracking. Third, the arrows connecting the steps are all of equal size, suggesting that a roughly equal amount of time will be spent at each step. Fourth, the cycle of events as diagrammed begins and ends at the door to the emergency room; events that occurred before arrival or follow-up actions and behaviors are not included as relevant parts of the system. While it would be incorrect to overstate the degree to which this chart reflects real ED staff consensus on how their work ought to be organized, it is close enough to act as a useful point of contrast with the de facto process that was observed in this study. In the next section, the ED process is re-examined using our research findings to reveal the ways in which emergency care is delivered at CHC. 7KH 2EVHUYHG &\FOH RI (YHQWV 7ULDJH. Before arriving at the ED, drivers and patients must navigate a complex series of side roads that, while well marked, can be hard to follow in an

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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nurse conducts a physical examination. If necessary, laboratory work and X-rays
are ordered. Once test results are received and interpreted, a physician consults
with the patient, offering a diagnosis and treatment plan. Finally, the patient is
either admitted to the hospital or discharged from the ED.
This ideal model makes a number of assumptions about the care process.
First, the ED visit is conceived of as linear, with each step regarded as
independent and following from another. Second, the arrows between the steps
are unidirectional, suggesting that patients always move forward and that there
is no backtracking. Third, the arrows connecting the steps are all of equal size,
suggesting that a roughly equal amount of time will be spent at each step.
Fourth, the cycle of events as diagrammed begins and ends at the door to the
emergency room; events that occurred before arrival or follow-up actions and
behaviors are not included as relevant parts of the system.
While it would be incorrect to overstate the degree to which this chart
reflects real ED staff consensus on how their work ought to be organized, it is
close enough to act as a useful point of contrast with the de facto process that
was observed in this study. In the next section, the ED process is re-examined
using our research findings to reveal the ways in which emergency care is
delivered at CHC.
7KH 2EVHUYHG &\FOH RI (YHQWV
7ULDJH. Before arriving at the ED, drivers and patients must navigate a
complex series of side roads that, while well marked, can be hard to follow in an


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