Monday, June 23, 2014

Persuasion techniques to get patients admitted from the emergency department to the hospital

Here's a really fascinating paper from the journal Social Science & Medicine. From the abstract:

This paper reports a discourse analysis of the language doctors used as they talked about and engaged in patient handoffs between the emergency department (ED) and various inpatient services...Although interest in handoff improvement has grown considerably in recent years, progress has been hampered, perhaps in part, because of a widely used but limiting conceptual model of handoff as an information transmission.

That last phrase (my italics) is rich and insightful. The handoff between ED and inpatient is complex. Though purportedly a simple conveyance of clinical information, much more lies beneath the surface. Many times it's a case of competing agendas. The ED physician, dealing with department crowding and long wait times, wants to get the patient dispo'd ASAP. The hospitalist is already three admissions behind and doesn't need another bomb dropped on his work flow.

Here are the key points listed in the introduction:

Doctors use metaphors of sales, sports, packages, and teamwork to describe handoff.
These metaphors illuminate the complicated social interactions of handoff.
Findings implicate various organizational and social structures.
The information transmission conceptual model of handoff is challenged.

The specialty of emergency medicine has many parallels to hospital medicine, one of which is the problem of discontinuity. Back in the 70s primary physicians evaluated their own patients in the ED and decided whether to admit them or send them home. There was no disconnect at the transition, no competing agenda and no need for gamesmanship.

Via Hospital Medicine Virtual Journal Club.

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