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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  15 individuals and keep them from sticking their heads in the triage area/room when it is not yet their turn to be seen. The triage area at CHC has both a front and back door (the latter of which leads into a somewhat more secure space), and one nurse explained that she always left the back door open in case she had to get away quickly. Triage requires a significant amount of emotional labor, both in dealing with unwanted intrusions and with difficult patients. The triage process itself is sense-making “par excellence” (Weick, 1995). Nurses begin with open-ended questions (e.g., “So, what brings you here today?”) but at the same time look to the situation and the patient’s appearance for clues. Patients arrive without past medical information, and in the majority of cases the triage nurse had nothing to go on to make accurate assessments other than the patient’s story, which wasn’t always reliable. Sometimes people would present their least serious symptoms first, leaving things like blood in the urine or a recent organ transplant for an “oh by the way” comment at the end of the triage process (referred to as “doorknob disclosures”). Yet, on most occasions, the triage nurses’ ability to gauge type and severity of illness was impressive. They become especially proficient at identifying patients who are faking symptoms to get attention. Over time, it seems that these nurses develop a number of assumptions and scripts to both manage and simplify the sense- making process; most of their errors likely come from jumping to wrong conclusions as a result of using faulty scripts.

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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15
individuals and keep them from sticking their heads in the triage area/room
when it is not yet their turn to be seen. The triage area at CHC has both a front
and back door (the latter of which leads into a somewhat more secure space), and
one nurse explained that she always left the back door open in case she had to
get away quickly. Triage requires a significant amount of emotional labor, both
in dealing with unwanted intrusions and with difficult patients.
The triage process itself is sense-making “par excellence” (Weick, 1995).
Nurses begin with open-ended questions (e.g., “So, what brings you here today?”)
but at the same time look to the situation and the patient’s appearance for clues.
Patients arrive without past medical information, and in the majority of cases
the triage nurse had nothing to go on to make accurate assessments other than
the patient’s story, which wasn’t always reliable. Sometimes people would
present their least serious symptoms first, leaving things like blood in the urine
or a recent organ transplant for an “oh by the way” comment at the end of the
triage process (referred to as “doorknob disclosures”). Yet, on most occasions,
the triage nurses’ ability to gauge type and severity of illness was impressive.
They become especially proficient at identifying patients who are faking
symptoms to get attention. Over time, it seems that these nurses develop a
number of assumptions and scripts to both manage and simplify the sense-
making process; most of their errors likely come from jumping to wrong
conclusions as a result of using faulty scripts.


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