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Interprofessional team dynamics and information flow management in emergency departments.

AIM
In Emergency Departments, fragmentation and breakdown in information exchange can be important factors leading to adverse events. This article aims to consider the critical aspects of collaborative teamwork in Emergency Departments that may have an impact on the information flow.


BACKGROUND
On the basis of Distributed Cognition Theory, we have assumed that cognitive outcomes in critical-care settings are not confined to the thoughts of isolated individuals; rather, they are better understood as properties of a distributed cognitive system across the minds of the clinical team members and across the technological artefacts.


DESIGN
We report on an exploratory ethnographic study of two Emergency Departments.


METHODS
Data were collected over a period of four months in 2008 via observation and interviews.


RESULTS
The results highlight a specific distribution of cognitive work between physicians and nurses. The nurse's roles as information highlighter, memory keeper and process organizer helped to ensure the information flow and to overcome some of the problems identified with the computer-assisted communication process. Such distribution of cognitive work improved care quality, but it crossed established professional boundaries.


CONCLUSION
As cross-boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast-moving contexts. To realize an interprofessional working system, practice-based training is required, aimed at developing a deep understanding of team cognition.