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Understanding communication between emergency and consulting physicians: a qualitative study that describes and defines the essential elements of the emergency department consultation-referral process for the junior learner

Published online by Cambridge University Press:  04 March 2015

Teresa Chan ,
Donika Orlich ,
Kulamakan Kulasegaram  and
Jonathan Sherbino
Teresa Chan*
Affiliation:
Division of Emergency Medicine, Department of Medicine
Donika Orlich
Affiliation:
Division of Emergency Medicine, Department of Medicine
Kulamakan Kulasegaram
Affiliation:
Health Research Methods Program, McMaster University, Hamilton, ON
Jonathan Sherbino
Affiliation:
Division of Emergency Medicine, Department of Medicine
*
McMaster Clinics Room 254, 247 Barton Street East, Hamilton, ON L8L 2X2; teresa.chan@medportal.ca

Abstract

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Objectives:

To define the important elements of an emergency department (ED) consultation request and to develop a simple model of the process.

Methods:

From March to September 2010, 61 physicians (21 emergency medicine [EM], 20 general surgery [GS], 20 internal medicine [IM]; 31 residents, 30 attending staff) were questioned about how junior learners should be taught about ED consultation. Two investigators independently reviewed focus group and interview transcripts using grounded theory to generate an index of themes until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. All transcripts were coded using this index of themes; 30% of transcripts were coded in duplicate to determine the agreement.

Results:

A total of 245 themes and subthemes were identified. The agreement between reviewers was 77%. Important themes in the process were as follows: initial preparation and review of investigations by EM physician (overall endorsement 87% [range 70–100% in different groups]); identification of involved parties (patient and involved physicians) (100%); hypothesis of patient's diagnosis (75% [range 62–83%]) or question for the consulting physician (70% [range 55–95%]); urgency (100%) and stability (74% [range 62–80%]); questions from the consultant (100%); discussion/communication (98% [range 95–100%]); and feedback (98% [range 95–100%]). These components were reorganized into a simple framework (PIQUED). Each clinical specialty significantly contributed to the model (χ2 = 7.9; p value = 0.019). Each group contributed uniquely to the final list of important elements (percent contributions: EM, 57%; GS, 41%; IM, 64%).

Conclusions:

We define important elements of an ED consultation with input from emergency and consulting physicians. We propose a model that organizes these elements into a simple framework (PIQUED) that may be valuable for junior learners.

Keywords

communicationconsultantsemergency medicineinterphysician communicationreferral and consultation
Type
Education • Enseignement
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 1 , January 2013 , pp. 42 - 51
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

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