title: Network analysis of team communication in a busy emergency department.
abstract: BACKGROUND
  The Emergency Department (ED) is consistently described as a high-risk environment for patients and clinicians that demands colleagues quickly work together as a cohesive group. Communication between nurses, physicians, and other ED clinicians is complex and difficult to track. A clear understanding of communications in the ED is lacking, which has a potentially negative impact on the design and effectiveness of interventions to improve communications. We sought to use Social Network Analysis (SNA) to characterize communication between clinicians in the ED.
  
  
  METHODS
  Over three-months, we surveyed to solicit the communication relationships between clinicians at one urban academic ED across all shifts. We abstracted survey responses into matrices, calculated three standard SNA measures (network density, network centralization, and in-degree centrality), and presented findings stratified by night/day shift and over time.
  
  
  RESULTS
  We received surveys from 82% of eligible participants and identified wide variation in the magnitude of communication cohesion (density) and concentration of communication between clinicians (centralization) by day/night shift and over time. We also identified variation in in-degree centrality (a measure of power/influence) by day/night shift and over time.
  
  
  CONCLUSIONS
  We show that SNA measurement techniques provide a comprehensive view of ED communication patterns. Our use of SNA revealed that frequency of communication as a measure of interdependencies between ED clinicians varies by day/night shift and over time.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. pattersond@upmc.edu
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Patterson
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Pfeiffer
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Weaver
authors.forename: David
authors.initials: D
authors.lastname: Krackhardt
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008875:Middle Aged; D019982:Organizational Case Studies; D010348:Patient Care Team; D010414:Pennsylvania; D060756:Social Networking; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D013997:Time Factors; D055815:Young Adult