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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. 1 Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  2. 2 Harvard Medical School, Harvard University, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Channing 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

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:http://creativecommons.org/licenses/by-nc/4.0/.

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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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