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Emerg Med J. 2018 Jul;35(7):406-411. doi: 10.1136/emermed-2017-207119. Epub 2018 Feb 3.

Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey.

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Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.



Our aim was to determine whether emergency physicians (EPs) felt their standard patient evaluation practice was modified by two non-private clinical encounters: hallway encounters and encounters during which a companion was present.


We administered an iteratively developed cross-sectional survey at an annual national professional meeting. We used logistic regression to compare relationships among non-private clinical encounters and predictors of interest.


409 EPs completed the survey. EPs deviated from standard history-taking when practising in a hallway location (78%) and when patients had a companion (84%). EPs altered their standard physical exam when practising in a hallway location (90%) and when patients had a companion (77%). EPs with at least a decade of experience were less likely to alter history-taking in the hallway (OR 0.55, 95% CI 0.31 to 0.99). Clinicians who frequently evaluated patients in the hallway reported delays or diagnostic error-related to altered history-taking (OR 2.34, 95% CI 1.33 to 4.11). The genitourinary system was the most common organ system linked to a delay or diagnostic error. Modifications in history-taking were linked to delays or failure to diagnose suicidal ideation or self-harm (25%), intimate partner violence (40%), child abuse (12%), human trafficking (8%), substance abuse (47%) and elder abuse (17%).


Our study suggests that alterations in EP usual practice occurs when the doctor-patient dyad is disrupted by evaluation in a hallway or presence of a companion. Furthermore, these disruptions are associated with delays in care and failure to diagnosis medical, social and psychiatric conditions.


crowding; diagnosis; errors; suicide; violence, interpersonal

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