title: Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department.
abstract: OBJECTIVE
  To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department.
  
  
  BACKGROUND
  Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication.
  
  
  METHODS
  A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview.
  
  
  METHODS
  Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis.
  
  
  RESULTS
  Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation.
  
  
  CONCLUSIONS
  The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges.
  
  
  CONCLUSIONS
  The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings.
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong, China.|The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.|Department of Education, St Antony's College, University of Oxford, Oxford, UK.
authors.forename: Jack Kh
authors.initials: JK
authors.lastname: Pun
authors.affiliation: The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.|School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Engle Angela
authors.initials: EA
authors.lastname: Chan
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong, China.|The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Murray
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong, China.|The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.|Department of Education, St Antony's College, University of Oxford, Oxford, UK.|Faculty of Arts and Social Science, The University of Technology Sydney, Australia.
authors.forename: Diana
authors.initials: D
authors.lastname: Slade
authors.affiliation: Department of English, The Hong Kong Polytechnic University, Hong Kong, China.|The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.
authors.forename: Christian Mim
authors.initials: CM
authors.lastname: Matthiessen
mesh_terms: D000328:Adult; D003142:Communication; D003144:Communication Barriers; D004630:Emergencies / Q000523:psychology; D004636:Emergency Service, Hospital; D005260:Female; D006723:Hong Kong; D006801:Humans; D007398:Interpersonal Relations; D007802:Language; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Chinese patients; clinician-clinician communication; clinician-patient communication; discourse analysis; emergency department; patient safety; spoken interactions; trilingual