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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  25 Very often, the demand for services is greater than the number of beds in the ED. The large dry-erase board in the CHC ED provides a snapshot of the current patient load and tells who is working that day and in what capacity, the current occupancy, and the number of admitted patients waiting for a bed “upstairs” in the hospital. When the ED beds are all full, patients are “bunk- bedded,” which means that they are placed in the hallway for evaluation and treatment. When this happens, staff and patient privacy are severely compromised. As a result there is no backstage area (Goffman, 1959) where the ED staff can relax away from public scrutiny. Moreover, lack of privacy is a serious obstacle to both patient and employee satisfaction. Especially in EDs without hard rooms and walls (like the one at CHC), privacy is a huge patient concern (the most recent patient satisfaction survey at CHC confirmed this assumption). In the absence of strong leadership, it is easy for staff to get lax in this area. During this study, physicians and nurses were making an extra effort to be mindful about where they shared patient information and who was within earshot. A related obstacle was the lack of coordination between physicians, nurses, and other staff in communicating with patients and their families. In responding to patients’ questions, it is difficult to be consistent when there is little time and no private space to confer and share information. To be most effective, it seems that EDs require a clearly defined “backstage” area where care providers can talk and develop a common approach.

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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25
Very often, the demand for services is greater than the number of beds in
the ED. The large dry-erase board in the CHC ED provides a snapshot of the
current patient load and tells who is working that day and in what capacity, the
current occupancy, and the number of admitted patients waiting for a bed
“upstairs” in the hospital. When the ED beds are all full, patients are “bunk-
bedded,” which means that they are placed in the hallway for evaluation and
treatment. When this happens, staff and patient privacy are severely
compromised. As a result there is no backstage area (Goffman, 1959) where the
ED staff can relax away from public scrutiny.
Moreover, lack of privacy is a serious obstacle to both patient and employee
satisfaction. Especially in EDs without hard rooms and walls (like the one at
CHC), privacy is a huge patient concern (the most recent patient satisfaction
survey at CHC confirmed this assumption). In the absence of strong leadership,
it is easy for staff to get lax in this area. During this study, physicians and
nurses were making an extra effort to be mindful about where they shared
patient information and who was within earshot.
A related obstacle was the lack of coordination between physicians, nurses,
and other staff in communicating with patients and their families. In
responding to patients’ questions, it is difficult to be consistent when there is
little time and no private space to confer and share information. To be most
effective, it seems that EDs require a clearly defined “backstage” area where
care providers can talk and develop a common approach.


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