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Better communication in the emergency department.

BACKGROUND
The emergency nurse practitioner (ENP) role has evolved since the 1980s, when it was introduced into emergency departments (EDs) in the UK (Tye 1997). Nowadays, ENPs see, treat and refer or discharge patients autonomously. They also document patient histories and are expected to communicate effectively with patients who have complex needs. The role has expanded for several reasons, including the need to reduce doctors' working hours, but mainly to make more flexible use of services. Meanwhile, as ED attendances increase (Thompson et aL 2010), ENPs are placed under increasing pressure and may be forced to spend less time with patients than was expected of them when the ENP role was originally devised. This can affect patient history taking and communication, and may lead to poorer patient outcomes and satisfaction.


AIM
This article concerns a literature review undertaken by the author to identify and overcome the limitations to effective history taking and communication among ENPs. It also highlights good practice in the management of emergency and urgent-care patients with complex needs.


METHODS
There is little primary research on history taking and communication pressures in emergency care but, after a systematic literature search of the British Nursing Index, CINAHL and Medline databases, the author identified eight research articles on the subject.


RESULTS
Three themes emerged from the review: interruptions, overload and barriers. According to the review findings, interruptions occur more often in EDs than in primary care settings, and senior doctors and senior nurses are interrupted more often than other staff. These interruptions can increase information overload, leading to medical errors and adverse clinical outcomes. The main barrier to effective history taking is a failure to understand patients who have poor command of the English language.


CONCLUSION
The author's recommendations for practice include increasing the number of staff and training them in managing pressure, communicating effectively with patients, and ensuring where appropriate that doors and curtains are closed to reduce the number and extent of interruptions.