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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  16 In summary, triage is an unpredictable, insecure, emotional environment, in which talented nurses engage in ongoing sense-making to classify the nature and severity of a patient’s illness. The process is made more difficult by a changing patient profile that increasingly includes older adults, the uninsured, substance abusers and those with poorly controlled mental disorders. Despite all of these challenges, triage at CHC does an efficient job of seeing patients quickly and sending them on to registration. The majority of negative experiences that may carry over to the rest of the visit happen in the first minute after arrival, where a patient is agitated and unclear about where in the area to go to seek help prior top seeing the triage nurse. 5HJLVWUDWLRQ. Once a patient makes it through triage, he or she is directed to a back hallway where they must register. Registration clerks sit behind glass walls that only allow them to slip paperwork underneath the glass, like you would to a bank teller. While we did not observe any patients who were overtly critical of this barrier, many of the staff told us that they didn’t like what this design symbolized about the hospital’s perception of patients. During the time period covered by the study, management seriously considered (but did not implement) relocating the registration department, or taking down the glass partitions to allow a more personable connection with patients. During the observation period, laptop computers on rolling carts were purchased by the Information Technology department to facilitate a move to bedside registration, which is standard procedure at many hospital EDs. The

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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16
In summary, triage is an unpredictable, insecure, emotional environment,
in which talented nurses engage in ongoing sense-making to classify the nature
and severity of a patient’s illness. The process is made more difficult by a
changing patient profile that increasingly includes older adults, the uninsured,
substance abusers and those with poorly controlled mental disorders. Despite
all of these challenges, triage at CHC does an efficient job of seeing patients
quickly and sending them on to registration. The majority of negative
experiences that may carry over to the rest of the visit happen in the first
minute after arrival, where a patient is agitated and unclear about where in the
area to go to seek help prior top seeing the triage nurse.
5HJLVWUDWLRQ. Once a patient makes it through triage, he or she is directed
to a back hallway where they must register. Registration clerks sit behind glass
walls that only allow them to slip paperwork underneath the glass, like you
would to a bank teller. While we did not observe any patients who were overtly
critical of this barrier, many of the staff told us that they didn’t like what this
design symbolized about the hospital’s perception of patients. During the time
period covered by the study, management seriously considered (but did not
implement) relocating the registration department, or taking down the glass
partitions to allow a more personable connection with patients.
During the observation period, laptop computers on rolling carts were
purchased by the Information Technology department to facilitate a move to
bedside registration, which is standard procedure at many hospital EDs. The


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