title: Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong.
abstract: BACKGROUND
  This study investigates clinicians' views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong.
  
  
  METHODS
  Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs.
  
  
  RESULTS
  The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians' engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills.
  
  
  CONCLUSIONS
  These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety.
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China. jackpun@me.com.|The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia. jackpun@me.com.|Department of Education, St Antony's College, University of Oxford, Oxford, UK. jackpun@me.com.
authors.forename: Jack K H
authors.initials: JK
authors.lastname: Pun
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.|The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia.
authors.forename: Christian M I M
authors.initials: CM
authors.lastname: Matthiessen
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.|The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Murray
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.|The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia.|Faculty of Arts and Social Science, The University of Technology Sydney, Sydney, Australia.
authors.forename: Diana
authors.initials: D
authors.lastname: Slade
keywords: Clinician-clinician communication; Clinician-patient communication; Emergency medicine; Interviews; Quality of care