Does Intradisciplinary Conflict Influence to Outcomes of Emergency Medicine Residency Program? A Mixed Methods Study

Abstract

Objective: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors. Methods: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach. Results: The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits. Conclusion: This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

Conflict in emergency medicine: A systematic review

“…noted that IM physicians express apprehension about unwarranted hospital admissions, whereas their ED counterparts emphasize reasons for admission, such as comprehensive outpatient care guidance. Conflict and miscommunication also occur within ED staff and/or between the ED and other services, such as outpatient, general practitioner, and prehospital services 18–24 …”

“…Conflict and miscommunication also occur within ED staff and/or between the ED and other services, such as outpatient, general practitioner, and prehospital services. [18][19][20][21][22][23][24] Other studies ascribed inefficiencies within the handover process itself as the main driving force for conflict. [25][26][27] The focus of three other articles was conflict arising from ED crowding (i.e., excessive patient volume overwhelming ED capacity) and high workload.…”

“…17,19 IM doctors are often concerned about unnecessary admissions and may perceive the workup standards of the ED to be subpar, thus introducing delays to the admission process. 6,17,18,41,43 This disparity is exemplified in the study from Horwitz et al 39 where a patient initially diagnosed with pneumonia in the ED was later found to have a pulmonary embolism. The IM physician categorized this as a diagnostic error that led to improper care, while ED physicians view their role as stabilization and disposition and considered the patient suitable for admission with a provisional diagnosis.…”

Workplace interpersonal conflict in prehospital emergency: Concept analysis

“…[ 21 ] In the searched documents, some of the antecedents of WIC were personality and/or value differences, blurred job boundaries, the fight for scarce resources, decision-making, poor communication, competition amongst departments, unreasonable work expectations (policies, rules, deadlines, time restriction), unmet and/or unrealistic expectations (regarding salary, advancement, or workload). Most conflict research reveals that the majority of health care conflict arises from “interpersonal or professional communication difficulties.”[ 1 2 3 5 11 13 39 43 45 46 47 57 58 59 60 ]…”

“…In the searched documents, some of the destructive consequences of WIC were depressive disorders and poor mental health, physical ailments such as pain, job dissatisfaction, burnout, higher absenteeism, and diminished teamwork. [ 1 2 3 11 13 39 43 45 46 47 57 58 59 60 ]…”