Interprofessional team dynamics and information flow management in emergency departments.
Aim: In Emergency Departments, fragmentation and breakdown in information exchange can be important factors leading to adverse events. This article aims to consider the critical aspects of collaborative teamwork in Emergency Departments that may have an impact on the information flow. Background: On the basis of Distributed Cognition Theory, we have assumed that cognitive outcomes in critical care settings are not confined to the thoughts of isolated individuals; rather, they are better understood as properties of a distributed cognitive system across the minds of the clinical team members and across the technological artefacts. Design: We report on an exploratory ethnographic study of two Emergency Departments. Methods: Data were collected over a period of four months in 2008 via observation and interviews. Results: The results highlight a specific distribution of cognitive work between physicians and nurses. The nurse's roles as information highlighter, memory keeper and process organizer helped to ensure the information flow and to overcome some of the problems identified with the computer assisted communication process. Such distribution of cognitive work improved care quality, but it crossed established professional boundaries. Conclusion: As cross boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast moving contexts. To realize an interprofessional working system, practice based training is required, aimed at developing a deep understanding of team cognition. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Divided into three phases after the preliminary interviews with ED heads: (a) from the moment the patient arrived at triage until he/she entered the treatment room; (b) from the first visit until the second clinical assessment; and (c) from the second clinical assessment until the decision to discharge or to admit the patient.
Exploratory ethnographic study
During the preliminary phase, we implemented five semistructured individual interviews with the quality control manager, the head nurses and the heads of the EDs. Then we held a meeting with all of them to jointly define the main aspects of the research design and to establish the unit of analysis, the times and modes of the observation and the communication strategy.
Data were collected over a period of four months in 2008 via observation and interviews.
This article aims to consider the critical aspects of collaborative teamwork in Emergency Department that may have an impact on the information flow
Choice of the mini team as the unit of analysis. While preserving the participants’ perspective, this led to neglecting aspects of the broader organizational context (e.g. laboratory teams, other specialists), which might affect workflow and patient safety.Another limitation was that we did not collect data regarding the relationship between strategies used by nurses to monitor and support information flow and patient safety. It would be interesting to study in depth how the observed distribution of cognitive work improves a team’s ability to recover errors before they affect the patients.
As cross-boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast-moving contexts. To realize an interprofessional working system, practice-based training is required, aimed at developing a deep understanding of team cognition
As recommended by the Italian Ethics Committee (ComitatoNazionale di Bioetica– Raccomandazione del 13/7/2001),the approval for data collection was provided by the clinicaldirector.
The research focused primarily on the patterns of information exchange and thedistribution of tasks adopted by healthcare teams.
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