Written by Vivian Lei
Successful communication between emergency physicians and nurses requires strategies to improve knowledge sharing, streamlining plan of care, acknowledging patient status changes, and awareness of team dynamics.
Why does this matter?
Communication in the ED is vital for safe and effective care, but it can also be challenging to implement. This research conducted focus groups and performed a concept-mapping analysis among emergency physicians and nurses to identify shared information needs, communication strategies and barriers, and factors affecting successful communication. These were distilled into 10 best practices.
10 commandments of physician – nurse communication:
Communicate diagnostic assessment, plan of care and disposition plan to other team members as early as possible. Update the team of any changes to the plan.
Communicate pending tasks in the patient’s care as well as information regarding changes or holdups to tasks or orders.
Communicate details regarding proactive diagnostic testing and therapeutic interventions (e.g. placing IV and drawing bloodwork prior the physician evaluation in patients with abdominal pain, obtaining urine HCG in women of childbearing age).
Don’t assume everyone has a shared understanding: recognize that you might have unique access to information and make sure that it is shared in a timely manner.
Notify providers of any critical or unexpected changes in vital signs or patient status. Did the patient develop new tachycardia, fever, or hypotension? Is the patient more somnolent or getting more agitated?
Do not assume electronic orders substitute for verbal communication.
Use asynchronous communication for lower priority items to aid in prioritization (e.g. leaving a note for a physician requesting they sign-off on non-urgent orders).
Adapt communication strategies based on team members’ experience level and existing relationships. For example, a new nurse may need extra time and guidance while orienting.
Adapt communication strategies to the physical layout of the ED, especially in those facilities where nurses and physicians may have workstations out of sight from one another or where it is not obvious which staff members are on different care teams.
Use strategies that exploit provider experience level regardless of role hierarchy. Perhaps we all remember being a fresh resident physician (finally a doctor!) and realizing that we knew very little compared to the seasoned charge nurse.
Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication. J Emerg Med. 2020 Mar 4. pii: S0736-4679(19)30939-4. doi: 10.1016/j.jemermed.2019.10.035. [Epub ahead of print]
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