title: Objective Assessment and Thematic Categorization of Patient-audible Information in an Emergency Department.
abstract: OBJECTIVE
  The objective was to assess and categorize the understandable components of patient-audible information (e.g., provider conversations) in emergency department (ED) care areas and to initiate a baseline ED soundscape assessment.
  
  
  METHODS
  Investigators at an academic referral hospital accessed 21 deidentified transcripts of recordings made with binaural in-ear microphones in patient rooms (n = 10) and spaces adjacent to nurses' stations (n = 11), during ED staff sign-outs as part of an approved quality management process. Transcribed materials were classified by speaker (health care provider, patient/family/friend, or unknown). Using qualitative analysis software and predefined thematic categories, two investigators then independently coded each transcript by word, phrase, clause, and/or sentence for general content, patient information, and HIPAA-defined patient identifiers. Scheduled reviews were used to resolve any data coding discrepancies.
  
  
  RESULTS
  Patient room recordings featured a median of 11 (interquartile range [IQR] = 2 to 33) understandable words per minute (wpm) over 16.2 (IQR = 15.1 to 18.4) minutes; nurses' station recordings featured 74 (IQR = 47 to 109) understandable wpm over 17.0 (IQR = 15.4 to 20.3) minutes. Transcript content from patient room recordings was categorized as follows: clinical, 44.8% (IQR = 17.7% to 62.2%); nonclinical, 0.0% (IQR = 0.0% to 0.0%); inappropriate (provider), 0.0% (IQR = 0.0% to 0.0%); and unknown, 6.0% (IQR = 1.7% to 58.2%). Transcript content from nurses' stations was categorized as follows: clinical, 86.0% (IQR = 68.7% to 94.7%); nonclinical, 1.2% (IQR = 0.0% to 19.5%); inappropriate (provider), 0.1% (IQR = 0.0% to 2.3%); and unknown, 1.3% (IQR = 0.0% to 7.1%). Limited patient information was audible on patient room recordings. Audible patient information at nurses' stations was coded as follows (median words per sign-out sample): general patient history, 116 (IQR = 19 to 206); social history, 12 (IQR = 4 to 19); physical examination, 39 (IQR = 19 to 56); imaging results, 0 (IQR = 0 to 21); laboratory results, 7 (IQR = 0 to 22); other results, 0 (IQR = 0 to 3); medical decision-making, 39 (IQR = 10 to 69); management (general), 118 (IQR = 79 to 235); pain management, 4 (IQR = 0 to 53); and disposition, 42 (IQR = 22 to 60). Medians of 0 (IQR = 0 to 0) and 3 (IQR = 1 to 4) patient name identifiers were audible on in-room and nurses' station sign-out recordings, respectively.
  
  
  CONCLUSIONS
  Sound recordings in an ED setting captured audible and understandable provider discussions that included confidential, protected health information and discernible quantities of nonclinical content.
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Xiao C
authors.initials: XC
authors.lastname: Zhang
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.|Lifespan Medical Simulation Center, Providence, RI.
authors.forename: Leo
authors.initials: L
authors.lastname: Kobayashi
authors.affiliation: Department of Interior Architecture, Rhode Island School of Design, Providence, RI.|Department of Industrial Design, Rhode Island School of Design, Providence, RI.
authors.forename: Markus
authors.initials: M
authors.lastname: Berger
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Pranav M
authors.initials: PM
authors.lastname: Reddy
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Darin B
authors.initials: DB
authors.lastname: Chheng
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Gorham
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Shivany
authors.initials: S
authors.lastname: Pathania
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Stern
authors.affiliation: Department of Interior Architecture, Rhode Island School of Design, Providence, RI.|Department of Industrial Design, Rhode Island School of Design, Providence, RI.
authors.forename: Elio
authors.initials: E
authors.lastname: Icaza Milson
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.|School of Engineering of Brown University, Providence, RI.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Jay
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Baruch
mesh_terms: D000046:Academic Medical Centers; D003142:Communication; D003219:Confidentiality; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D036301:Qualitative Research