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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  22 perform. Much of emergency medicine depends upon a nurse’s ability to act decisively and properly in stressful situations, and not every nurse has the requisite temperament and skills to succeed in this environment. Bolton (2001) reveals how significant (and difficult) it is for nurses to manage emotions and present an appropriate professional disposition. 7HVW 5HVXOWV DQG ,QWHUSUHWDWLRQV. As has already been discussed, the ED process begins with triage making an initial determination of patient disposition based on vital signs and the patient’s story. Registration is next, followed as a rule by a long wait in the waiting room before the patient is brought back to a bed and a physical exam is conducted. At this point, more detailed hypotheses are developed about the cause of the patient’s symptoms; in most cases, some combination of x-rays and laboratory tests are ordered. If the first critical handoff in this ER is from triage to evaluation, the second is between evaluation and learning the results of these tests. Surprisingly, there is no well-developed system for knowing when tests will be complete, or for checking on them when they are done. As a consequence, patients and their families once again expect fast service and have this expectation violated. Patients and families put constant pressure on the staff (really, anyone within shouting distance) in an effort to determine if their lab results have come back, but no one on staff seems either willing or, more likely, able to provide a straight answer.

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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perform. Much of emergency medicine depends upon a nurse’s ability to act
decisively and properly in stressful situations, and not every nurse has the
requisite temperament and skills to succeed in this environment. Bolton (2001)
reveals how significant (and difficult) it is for nurses to manage emotions and
present an appropriate professional disposition.
7HVW 5HVXOWV DQG ,QWHUSUHWDWLRQV. As has already been discussed, the ED
process begins with triage making an initial determination of patient disposition
based on vital signs and the patient’s story. Registration is next, followed as a
rule by a long wait in the waiting room before the patient is brought back to a
bed and a physical exam is conducted. At this point, more detailed hypotheses
are developed about the cause of the patient’s symptoms; in most cases, some
combination of x-rays and laboratory tests are ordered.
If the first critical handoff in this ER is from triage to evaluation, the
second is between evaluation and learning the results of these tests.
Surprisingly, there is no well-developed system for knowing when tests will be
complete, or for checking on them when they are done. As a consequence,
patients and their families once again expect fast service and have this
expectation violated. Patients and families put constant pressure on the staff
(really, anyone within shouting distance) in an effort to determine if their lab
results have come back, but no one on staff seems either willing or, more likely,
able to provide a straight answer.


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