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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.

Author information

1
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
2
Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
3
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
4
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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%).

CONCLUSIONS:

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.

KEYWORDS:

crowding; diagnosis; errors; suicide; violence, interpersonal

PMID:
29431142
DOI:
10.1136/emermed-2017-207119
[Indexed for MEDLINE]
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