title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada. teresa.chan@medportal.ca
authors.forename: Teresa
authors.initials: T
authors.lastname: Chan
authors.forename: Donika
authors.initials: D
authors.lastname: Orlich
authors.forename: Kulamakan
authors.initials: K
authors.lastname: Kulasegaram
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sherbino
mesh_terms: D000328:Adult; D032882:Comprehension; D004635:Emergency Medicine / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000458:organization & administration*; D009864:Ontario; D015397:Program Evaluation; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration*