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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  28 however, as a number of floor nurses expressed their displeasure with the change and threatened to resign. This is a good illustration of both the lack of systems consciousness (employees were protecting their own areas first and foremost) and the highly political nature of bed assignment. Discharging patients directly from the ED creates its own set of challenges. Patients that do not need to be admitted to the hospital often wait a long time for discharge instructions. Delays can be due to not receiving lab results in a timely way, staff shortages in the ED, or ED physicians and nurses having too many patients to discharge. The discharge process is lengthy and requires a great deal of paperwork. New technologies are available to streamline the discharge process, but they are not yet in use at CHC. Moreover, if triage can be characterized as a process of translation from the patient’s story to a health professional’s technical list (i.e., differential diagnosis), at discharge the translation process must go in reverse (Murphy & Eisenberg, 2002). The physician and nurse must take the diagnosis and treatment plan and explain to the patient what they must do to get better at home. The process is complex under the best circumstances, given what is known about listening behaviors, the risks of translation, patient compliance, and the amount of information that may be lost. In sum, our observations about the cycle of events in the emergency department often departed from the ideal cycle produced to shape patient expectations. The most significant breakdowns are time-related and occur when

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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however, as a number of floor nurses expressed their displeasure with the
change and threatened to resign. This is a good illustration of both the lack of
systems consciousness (employees were protecting their own areas first and
foremost) and the highly political nature of bed assignment.
Discharging patients directly from the ED creates its own set of challenges.
Patients that do not need to be admitted to the hospital often wait a long time
for discharge instructions. Delays can be due to not receiving lab results in a
timely way, staff shortages in the ED, or ED physicians and nurses having too
many patients to discharge. The discharge process is lengthy and requires a
great deal of paperwork. New technologies are available to streamline the
discharge process, but they are not yet in use at CHC.
Moreover, if triage can be characterized as a process of translation from the
patient’s story to a health professional’s technical list (i.e., differential
diagnosis), at discharge the translation process must go in reverse (Murphy &
Eisenberg, 2002). The physician and nurse must take the diagnosis and
treatment plan and explain to the patient what they must do to get better at
home. The process is complex under the best circumstances, given what is
known about listening behaviors, the risks of translation, patient compliance,
and the amount of information that may be lost.
In sum, our observations about the cycle of events in the emergency
department often departed from the ideal cycle produced to shape patient
expectations. The most significant breakdowns are time-related and occur when


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