{"pk":15291,"title":"“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center","subtitle":null,"abstract":"Introduction:\n Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. \nMethods:\n We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method.\nResults:\n From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). \nConclusions:\n Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency medicine, internal medicine, hospital medicine, interdisciplinary communication"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3d8864db","frozenauthors":[{"first_name":"Zahir","middle_name":"","last_name":"Kanjee","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Hospital Medicine Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts","department":"None"},{"first_name":"Christine","middle_name":"P.","last_name":"Beltran","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts","department":"None"},{"first_name":"C.","middle_name":"Christopher","last_name":"Smith","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Hospital Medicine Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Internal Medicine Residency Program, Boston, Massachusetts","department":"None"},{"first_name":"Jason","middle_name":"","last_name":"Lewis","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Matthew","middle_name":"M.","last_name":"Hall","name_suffix":"","institution":"Providence Regional Medical Center, Department of Emergency Medicine, Everett, Washington; Washington State University, Pullman, Washington","department":"None"},{"first_name":"Carrie","middle_name":"D.","last_name":"Tibbles","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Emergency Medicine Residency Program, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Office of Graduate Medical Education, Boston, Massachusetts","department":"None"},{"first_name":"Amy","middle_name":"M.","last_name":"Sullivan","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts","department":"None"}],"date_submitted":"2021-04-12T07:44:29-07:00","date_accepted":"2021-04-12T07:44:29-07:00","date_published":"2021-11-05T11:27:18-07:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/15291/galley/7753/download/"}]}