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Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey
  1. Hanni Stoklosa1,2,3,
  2. Meredith Scannell1,
  3. Zheng Ma1,2,
  4. Bernard Rosner2,4,
  5. Ashley Hughes1,
  6. J Stephen Bohan1,2
  1. 1Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Harvard University, Boston, Massachusetts, USA
  3. 3Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Hanni Stoklosa, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; hstoklosa{at}bwh.harvard.edu

Abstract

Objectives Our aim was to determine whether emergency physicians (EPs) felt their standard patient evaluation practice was modified by two non-private clinical encounters: hallway encounters and encounters during which a companion was present.

Methods We administered an iteratively developed cross-sectional survey at an annual national professional meeting. We used logistic regression to compare relationships among non-private clinical encounters and predictors of interest.

Results 409 EPs completed the survey. EPs deviated from standard history-taking when practising in a hallway location (78%) and when patients had a companion (84%). EPs altered their standard physical exam when practising in a hallway location (90%) and when patients had a companion (77%). EPs with at least a decade of experience were less likely to alter history-taking in the hallway (OR 0.55, 95% CI 0.31 to 0.99). Clinicians who frequently evaluated patients in the hallway reported delays or diagnostic error-related to altered history-taking (OR 2.34, 95% CI 1.33 to 4.11). The genitourinary system was the most common organ system linked to a delay or diagnostic error. Modifications in history-taking were linked to delays or failure to diagnose suicidal ideation or self-harm (25%), intimate partner violence (40%), child abuse (12%), human trafficking (8%), substance abuse (47%) and elder abuse (17%).

Conclusions Our study suggests that alterations in EP usual practice occurs when the doctor–patient dyad is disrupted by evaluation in a hallway or presence of a companion. Furthermore, these disruptions are associated with delays in care and failure to diagnosis medical, social and psychiatric conditions.

  • violence, interpersonal
  • suicide
  • diagnosis
  • errors
  • crowding

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Footnotes

  • Contributors All authors contributed to the original idea for the paper and the writing and revision of it. HS and BR performed the data analysis. HS wrote the original draft.

  • Funding This work was supported by the Tynan Fellowship, Mary Horrigan Connors Center for Women’s Health & Gender Biology, Brigham and Women’s Hospital and an intradepartmental grant of the Department of Emergency Medicine, Brigham and Women’s Hospital.

  • Competing interests None declared.

  • Ethics approval Partners IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data are available, by email request, from the corresponding author.

  • Correction notice This article has been corrected since it was published Online First. A typo in the ’Key messages' box has been fixed (’What this study adds' section: ’alteration' instead of ’alternation').

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