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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  21 for how long they will likely be there. As a result, the patient ends up comparing the wait time with a wait at a restaurant or for some other service, and find it to be excessive. From the ED staff perspective, however, wait times should fairly be compared with how long it would have taken to see the primary care physician, which could be weeks or months. In any case, the initial physical exam in the ED is received by most patients with a mixture of irritation and relief. When the staff consciously employs good communication and service skills, this can reduce the griping considerably and even set the patient’s mind at ease. Another challenge at this point, however, is having the right tools and supplies to conduct the examination. In too many cases, rooms were not stocked, and important equipment (e.g., IV poles, blood pressure monitors, pillows and even beds) was missing or hard to locate. This seemed to be more frustrating to the staff than it was to the patients, but in all likelihood the frustration over missing supplies makes keeping a positive attitude and providing excellent care to patients all the more difficult. A final issue that emerges at the point of physical examination is the qualifications of nurses working in the ER. One consequence of the nursing shortage has been a desire on the part of hospital recruiters to dig deeper into applicant pools for candidates, resulting in a greater number of nurses assigned to the ER without the appropriate skills. ED employees find these decisions dubious, and feel that it is better to be short-staffed than to hire people who can’t

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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for how long they will likely be there. As a result, the patient ends up comparing
the wait time with a wait at a restaurant or for some other service, and find it to
be excessive. From the ED staff perspective, however, wait times should fairly
be compared with how long it would have taken to see the primary care
physician, which could be weeks or months.
In any case, the initial physical exam in the ED is received by most
patients with a mixture of irritation and relief. When the staff consciously
employs good communication and service skills, this can reduce the griping
considerably and even set the patient’s mind at ease. Another challenge at this
point, however, is having the right tools and supplies to conduct the
examination. In too many cases, rooms were not stocked, and important
equipment (e.g., IV poles, blood pressure monitors, pillows and even beds) was
missing or hard to locate. This seemed to be more frustrating to the staff than it
was to the patients, but in all likelihood the frustration over missing supplies
makes keeping a positive attitude and providing excellent care to patients all
the more difficult.
A final issue that emerges at the point of physical examination is the
qualifications of nurses working in the ER. One consequence of the nursing
shortage has been a desire on the part of hospital recruiters to dig deeper into
applicant pools for candidates, resulting in a greater number of nurses assigned
to the ER without the appropriate skills. ED employees find these decisions
dubious, and feel that it is better to be short-staffed than to hire people who can’t


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