Abstract
IntroductionPatient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context.MethodsWe performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method.ResultsFrom May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow).ConclusionsCauses of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.
Highlights
Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes
Two key themes emerged: 1) disagreements about disposition; and 2) contextual factors
Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the emergency medicine (EM)/IM interaction to potentially reduce conflict and advance patient care. [West J Emerg Med. 2021;22(6)1227–1239.]
Summary
Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. Evidence across healthcare settings suggests that suboptimal interdepartmental interactions and inadequately managed conflicts can lead to adverse impacts on patient safety, healthcare systems workflow, physician wellbeing, and employee retention.[7,8,9,10,11] For emergency medicine (EM)/ IM interactions unresolved conflicts and communication failures during patient handoffs between physicians are associated with higher risks of medical errors and adverse events.[9,12,13,14] Understanding the nature of interactions between these groups and optimizing collaboration during patient admission is a high priority for research and, patient safety and care.[6]
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