April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Diagnostic Sensemaking in Emergency Medicine: A Qualitative Multi-Site Study
Hospital emergency departments (EDs) are high stakes, high pressure communication environments in which clinical judgment, interpretation, and sensemaking have life or death consequences. That said, there is limited understanding of the salient real-time details of ED communication as related to diagnostic processes and associated performance shaping factors on the work system. The 2016 National Academy of Medicine report issued an urgent call for more research regarding diagnostic safety, making particular reference to the ED. Without systematic, in-depth analysis of the ED diagnostic process occurring as part of `real-time ED work’, the field will continue to struggle to design effective, sustainable interventions to improve diagnostic safety. The current study aims to address this lack of real world knowledge.
An interdisciplinary team of researchers conducted 50 interviews with ED clinicians as well as over 100 hours of structured observations of ED communication in an attempt to better understand the nature of diagnosis “in the wild.” Interviews and observations were done in three settings—urban/academic; suburban; and rural. We approached the study design with two theoretical frameworks in mind, seeking to determine how well they fit what we learned from our interviews and observations. The first framework is sensemaking theory, which maintains that organizational actors utilize communication to collectively reduce uncertainty, develop shared narratives, and decide on appropriate actions. The second focuses on the role of material objects in shaping organizational sensemaking and action.
Interview and observational data were analyzed using a combination of qualitative and quantitative methods. Our study revealed three key findings with implications for communication theory and practice. First, we discovered that the true aim of ED work is disposition, not diagnosis. The majority of ED work is focused on getting the patient in the best possible position to survive, not on identifying the root cause of their complaints, which is better left to physician visits outside of the ED. Second, we learned that despite societal expectations that all EDs are “equal”, EDs and the hospitals they are embedded in vary dramatically in terms of their capability to treat different conditions, including emergent ones. While the public assumes that all EDs can do everything one might need in an emergency, our findings suggest that in fact clinicians and care teams are acutely aware of their limited local capabilities, and use this awareness to guide the diagnostic process and decisions about treatment and optimal patient disposition or plan of care. Our research team concluded that when it comes to ED care and treatment, “geography is destiny.” Third, and finally, we discovered that emerging communication technologies such as EPIC chat are a double edged sword for ED communication and sensemaking. While on the one hand, these new tools allow for greater connectivity among geographically distributed members of the patient’s care team, their potentially asynchronous and less visible nature limit opportunities for collective sensemaking in real time.
An interdisciplinary team of researchers conducted 50 interviews with ED clinicians as well as over 100 hours of structured observations of ED communication in an attempt to better understand the nature of diagnosis “in the wild.” Interviews and observations were done in three settings—urban/academic; suburban; and rural. We approached the study design with two theoretical frameworks in mind, seeking to determine how well they fit what we learned from our interviews and observations. The first framework is sensemaking theory, which maintains that organizational actors utilize communication to collectively reduce uncertainty, develop shared narratives, and decide on appropriate actions. The second focuses on the role of material objects in shaping organizational sensemaking and action.
Interview and observational data were analyzed using a combination of qualitative and quantitative methods. Our study revealed three key findings with implications for communication theory and practice. First, we discovered that the true aim of ED work is disposition, not diagnosis. The majority of ED work is focused on getting the patient in the best possible position to survive, not on identifying the root cause of their complaints, which is better left to physician visits outside of the ED. Second, we learned that despite societal expectations that all EDs are “equal”, EDs and the hospitals they are embedded in vary dramatically in terms of their capability to treat different conditions, including emergent ones. While the public assumes that all EDs can do everything one might need in an emergency, our findings suggest that in fact clinicians and care teams are acutely aware of their limited local capabilities, and use this awareness to guide the diagnostic process and decisions about treatment and optimal patient disposition or plan of care. Our research team concluded that when it comes to ED care and treatment, “geography is destiny.” Third, and finally, we discovered that emerging communication technologies such as EPIC chat are a double edged sword for ED communication and sensemaking. While on the one hand, these new tools allow for greater connectivity among geographically distributed members of the patient’s care team, their potentially asynchronous and less visible nature limit opportunities for collective sensemaking in real time.