title: Interprofessional team dynamics and information flow management in emergency departments.
abstract: OBJECTIVE
  In Emergency Departments, fragmentation and breakdown in information exchange can be important factors leading to adverse events. This article aims to consider the critical aspects of collaborative teamwork in Emergency Departments that may have an impact on the information flow.
  
  
  BACKGROUND
  On the basis of Distributed Cognition Theory, we have assumed that cognitive outcomes in critical-care settings are not confined to the thoughts of isolated individuals; rather, they are better understood as properties of a distributed cognitive system across the minds of the clinical team members and across the technological artefacts.
  
  
  METHODS
  We report on an exploratory ethnographic study of two Emergency Departments.
  
  
  METHODS
  Data were collected over a period of four months in 2008 via observation and interviews.
  
  
  RESULTS
  The results highlight a specific distribution of cognitive work between physicians and nurses. The nurse's roles as information highlighter, memory keeper and process organizer helped to ensure the information flow and to overcome some of the problems identified with the computer-assisted communication process. Such distribution of cognitive work improved care quality, but it crossed established professional boundaries.
  
  
  CONCLUSIONS
  As cross-boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast-moving contexts. To realize an interprofessional working system, practice-based training is required, aimed at developing a deep understanding of team cognition.
authors.affiliation: Department of Economics, Management and Quantitative Methods, Università degli Studi di Milano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gilardi
authors.forename: Chiara
authors.initials: C
authors.lastname: Guglielmetti
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pravettoni
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003658:Decision Making, Computer-Assisted; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033181:Information Dissemination / Q000379:methods*; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration*; D011787:Quality of Health Care; D055815:Young Adult
keywords: computer-assisted information flow; emergency; ethnography; interprofessional care; nurse roles; nursing; teamwork