Background: This study investigates clinicians� views of clinician-patient and clinician-clinician communication,\nincluding key factors that prevent clinicians from achieving successful communication in a large, high-pressured\ntrilingual Emergency Department (ED) in Hong Kong.\nMethods: Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative\nethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using\nthe Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication.\nThrough thematic analyses, they identified the factors that impede communication most significantly, as well as the\nrelationship between these factors. This research highlights the significant communication issues and patterns in\nHong Kong EDs.\nResults: The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data\nrevealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the\ninterpersonal parameter (i.e. clinicians� engagements with patients and other clinicians) and (3) contextual factors\n(i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in\nknowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping,\nserious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of\nfocus on interpersonal skills.\nConclusions: These communication problems (experiential, interpersonal and contextual) are intertwined, creating a\ncomplex yet weak communication structure that compromises patient safety, as well as patient and clinician\nsatisfaction. The researchers argue that hospitals should develop and implement best-practice policies and\neducational programmes for clinicians that focus on the following: (1) understanding the primary causes of\ncommunication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear\nand consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the\nconditions that foster successful communication. The research provides a model for future research on the relationship\nbetween communication and the quality and safety of the patient safety.
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