Self-Reported Use of Communication Techniques in the Emergency Department

Abstract

Background

Communication is considered a core competency for physicians. However, the Emergency Department setting poses significant and unique communication challenges.

Objective

The objective of this study was to explore self-reported use and perceptions of effectiveness and feasibility of communication techniques used by Emergency Physicians for communication with patients.

Methods

This cross-sectional study utilized a previously published survey on eight communication techniques. Respondents were asked to quantify their personal use and perceptions of effectiveness and feasibility of each technique. Responses were analyzed for differences based on practice setting (community, academic) and provider role (attending, resident). The survey was administered to a convenience sample recruited at the national meeting of the American College of Emergency Physicians.

Results

One hundred and sixty-nine participants were enrolled (70.5% male; 55.8% attending physicians, 44.2% residents; 66.2% practiced in academic settings). Using simple language and speaking slowly to patients were the only techniques identified as being used routinely by a majority of the sample (92.2% and 61.3%, respectively). A majority of the sample ranked seven of the techniques as effective; all techniques were considered feasible in the Emergency Department. No differences were noted across provider role or practice setting.

Conclusion

The majority of respondents are not utilizing communication techniques, despite their own beliefs that the techniques are effective and easy to implement in the Emergency Department. Additional research is needed to determine the effectiveness of these techniques and relevant barriers to their use.

Introduction

According to the Institute of Medicine, >90 million Americans have difficulty understanding health information (1). Previous research has established a strong relationship between low literacy and poor health outcomes 2, 3, 4, 5, 6. Understanding how care providers are communicating new information to patients and how this communication can be improved is critical.

The Accreditation Council for Graduate Medical Education, the American Board of Medical Specialties, and the Joint Commission have established communication as a core competency for physicians 7, 8, 9. Although many providers are aware of communication techniques and believe that they are effective, this awareness has not translated into high rates of use (10). Furthermore, many efforts at improving communication with patients with low literacy have often focused on revising written materials rather than on addressing the spoken interaction (11).

Spoken interactions can be especially challenging in the Emergency Department (ED) environment. Time constraints, uncertainty, interruptions, staff changes, and overcrowding can act as barriers to good communication in the ED 12, 13. In addition, there is significant heterogeneity in the types of patients and types of medical problems encountered in the emergency setting, adding challenges to optimal communication. Consequently, many patients leave the ED without an understanding of their diagnosis, follow-up plan, or how to care for themselves at home 14, 15.

Several studies have begun to describe specific aspects of communication in the ED, including global patient assessments of the quality of communication, content analyses of audiorecorded conversations, and codifying the verbal utterances in the encounter for elements, such as rapport building and patient centeredness 16, 17, 18, 19, 20, 21. These studies highlight important aspects of the verbal communication that occurs in the ED; however, to our knowledge, no studies have quantified the use of different communication techniques in the ED environment. The objective of this study was to describe the self-reported use of provider–patient communication techniques in Emergency Medicine practice settings.