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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  20 and there is typically a six-month learning process to understand ED procedures, the flow of work, and adapt to the emotional nature of ED medicine. The stressful nature of ED medicine often results in significant staff turnover, which further increases the stress on incumbent employees. The ED staff is often asked to work extended hours, adding even more strain to already stressed-out personnel. During our visits, it was common to hear the nurses grumble about bonuses given to ED staff at other hospitals, shift differential pay, or what the hospital pays traveling nurses. A short time after this study got underway, the hospital implemented a program called “First Contact” designed to improve patient satisfaction. The ED staff were encouraged to think about initial interactions with patients and their families as critical moments in shaping attitudes and expectations, and to ensure that they do all they can to share relevant information and instill a sense of confidence in the hospital. More fundamentally, the ED physician group has also developed standards for timely greeting of patients once brought back to a bed. Of course, all communication occurs in context, and by the time these nurses and physicians begin their initial evaluation, the patient is already frustrated by the “normal” wait time. In some cases, the patient’s regular physician can make the problem worse. It has become a common practice for doctors who are either unwilling or unable to see their patients in a timely manner to tell them to go to the ED, but they fail to create a realistic expectation

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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20
and there is typically a six-month learning process to understand ED
procedures, the flow of work, and adapt to the emotional nature of ED medicine.
The stressful nature of ED medicine often results in significant staff turnover,
which further increases the stress on incumbent employees. The ED staff is
often asked to work extended hours, adding even more strain to already
stressed-out personnel. During our visits, it was common to hear the nurses
grumble about bonuses given to ED staff at other hospitals, shift differential
pay, or what the hospital pays traveling nurses.
A short time after this study got underway, the hospital implemented a
program called “First Contact” designed to improve patient satisfaction. The ED
staff were encouraged to think about initial interactions with patients and their
families as critical moments in shaping attitudes and expectations, and to
ensure that they do all they can to share relevant information and instill a sense
of confidence in the hospital. More fundamentally, the ED physician group has
also developed standards for timely greeting of patients once brought back to a
bed.
Of course, all communication occurs in context, and by the time these
nurses and physicians begin their initial evaluation, the patient is already
frustrated by the “normal” wait time. In some cases, the patient’s regular
physician can make the problem worse. It has become a common practice for
doctors who are either unwilling or unable to see their patients in a timely
manner to tell them to go to the ED, but they fail to create a realistic expectation


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