“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center

Introduction: Patient 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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Zahir Kanjee, Christine P. Beltran, C. Christopher Smith, Jason Lewis, Matthew M. Hall, Carrie D. Tibbles, Amy M. Sullivan
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/0e462decf40a461a96456084e5a74976
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:0e462decf40a461a96456084e5a74976
record_format	dspace
spelling	oai:doaj.org-article:0e462decf40a461a96456084e5a749762021-11-17T15:19:27Z“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center1936-901810.5811/westjem.2021.7.52762https://doaj.org/article/0e462decf40a461a96456084e5a749762021-09-01T00:00:00Zhttps://escholarship.org/uc/item/3d8864dbhttps://doaj.org/toc/1936-9018Introduction: Patient 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. Methods: We 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. Results: From 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). Conclusions: Causes 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.Zahir KanjeeChristine P. BeltranC. Christopher SmithJason LewisMatthew M. HallCarrie D. TibblesAmy M. SullivaneScholarship Publishing, University of CaliforniaarticleMedicineRMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENWestern Journal of Emergency Medicine, Vol 22, Iss 6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Zahir Kanjee Christine P. Beltran C. Christopher Smith Jason Lewis Matthew M. Hall Carrie D. Tibbles Amy M. Sullivan “Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center
description	Introduction: Patient 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. Methods: We 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. Results: From 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). Conclusions: Causes 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.
format	article
author	Zahir Kanjee Christine P. Beltran C. Christopher Smith Jason Lewis Matthew M. Hall Carrie D. Tibbles Amy M. Sullivan
author_facet	Zahir Kanjee Christine P. Beltran C. Christopher Smith Jason Lewis Matthew M. Hall Carrie D. Tibbles Amy M. Sullivan
author_sort	Zahir Kanjee
title	“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center
title_short	“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center
title_full	“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center
title_fullStr	“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center
title_full_unstemmed	“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center
title_sort	“friction by definition”: conflict at patient handover between emergency and internal medicine physicians at an academic medical center
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/0e462decf40a461a96456084e5a74976
work_keys_str_mv	AT zahirkanjee frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter AT christinepbeltran frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter AT cchristophersmith frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter AT jasonlewis frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter AT matthewmhall frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter AT carriedtibbles frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter AT amymsullivan frictionbydefinitionconflictatpatienthandoverbetweenemergencyandinternalmedicinephysiciansatanacademicmedicalcenter
_version_	1718425397123612672

“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center

Ejemplares similares