Abstract
BackgroundThe Emergency Department (ED) is consistently described as a high-risk environment for patients and clinicians that demands colleagues quickly work together as a cohesive group. Communication between nurses, physicians, and other ED clinicians is complex and difficult to track. A clear understanding of communications in the ED is lacking, which has a potentially negative impact on the design and effectiveness of interventions to improve communications. We sought to use Social Network Analysis (SNA) to characterize communication between clinicians in the ED.MethodsOver three-months, we surveyed to solicit the communication relationships between clinicians at one urban academic ED across all shifts. We abstracted survey responses into matrices, calculated three standard SNA measures (network density, network centralization, and in-degree centrality), and presented findings stratified by night/day shift and over time.ResultsWe received surveys from 82% of eligible participants and identified wide variation in the magnitude of communication cohesion (density) and concentration of communication between clinicians (centralization) by day/night shift and over time. We also identified variation in in-degree centrality (a measure of power/influence) by day/night shift and over time.ConclusionsWe show that SNA measurement techniques provide a comprehensive view of ED communication patterns. Our use of SNA revealed that frequency of communication as a measure of interdependencies between ED clinicians varies by day/night shift and over time.
Highlights
The Emergency Department (ED) is consistently described as a high-risk environment for patients and clinicians that demands colleagues quickly work together as a cohesive group
We received 336 Social Network Analysis (SNA) surveys completed by 103 unique respondents, with 70 of those respondents completing more than one survey
Values of network density were greatest for the day shift on week 5 for team communication related to general problem solving and social issues while it was highest on week 8 for the day shift for communications related to medication advice. (The value of network density for communications related to general social problem advice and social issues attained a second peak on week 8)
Summary
Communication between nurses, physicians, and other ED clinicians is complex and difficult to track. We sought to use Social Network Analysis (SNA) to characterize communication between clinicians in the ED. The Joint Commission and other leading authorities of quality and safety in the United States identified communication lapses as responsible for a large proportion of poor patient and provider outcomes [4,5]. Improving communication between teammates is a central theme in safety improvement in healthcare, aviation, and other high-risk industries [6,7]. Communication between care providers in the Emergency Department (ED) is essential for the delivery of safe and effective care [8]. Measurement of team communication is complex [18]. Identifying the best method for communication analysis, especially in the ED, is an obstacle to investigating team communication and performance [16]
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