Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication


On behalf of all our Emergency Physicians, we want to thank the most valuable asset we have….. our super-skilled, resourceful, caring ……. ER Nurses


How can we improve our communication?


Thanks to Dr. Mekwan for recommending this article


Communication between nurses and emergency medicine (EM) providers is critical to the safe and effective care of patients in the emergency department. Understanding interactions and information needs among clinical team members can not only aid in communication, but can also provide a framework for training and the design of workflow and health information technology systems.


Top Ten Best Practices for Improving Communication in the ED


  1. Communicate diagnostic assessment, plan of care and disposition plan to other team members as early as possible. Update the team of any changes to the plan.
  2. Communicate pending tasks in the patient’s care as well as information regarding changes or holdups to tasks or orders.
  3. Communicate details regarding proactive diagnostic testing and therapeutic interventions (e.g. placing IV and drawing bloodwork prior the physician evaluation in patients with abdominal pain, obtaining urine HCG in women of childbearing age).
  4. Don’t assume everyone has a shared understanding: recognize that you might have unique access to information and make sure that it is shared in a timely manner.
  5. Notify providers of any critical or unexpected changes in vital signs or patient status. Did the patient develop new tachycardia, fever, or hypotension? Is the patient more somnolent or getting more agitated?
  6. Do not assume electronic orders substitute for verbal communication.
  7. Use asynchronous communication for lower priority items to aid in prioritization (e.g. leaving a note for a physician requesting they sign-off on non-urgent orders).
  8. Adapt communication strategies based on team members’ experience level and existing relationships. For example, a new nurse may need extra time and guidance while orienting.
  9. Adapt communication strategies to the physical layout of the ED, especially in those facilities where nurses and physicians may have workstations out of sight from one another or where it is not obvious which staff members are on different care teams.
  10. Use strategies that exploit provider experience level regardless of role hierarchy. Perhaps we all remember being a fresh resident physician (finally a doctor!) and realizing that we knew very little compared to the seasoned charge nurse.





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