The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department
Introduction: Older patients with complex care needs are increasingly seen in the emergency department (ED), requiring patient-centered care that involves collaboration among multiple specialists. Inadequate interphysician collaboration (IPhC) can increase the risk of adverse outcomes. Although the...
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Elsevier
2025-06-01
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| Series: | SSM: Qualitative Research in Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667321525000447 |
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| author | M. van der Ven N. Looman N. Ergun- Al Kafadji S. Dalloyaux O. Sir J. Braspenning C. Fluit W. Kuijer-Siebelink D. van Asselt |
| author_facet | M. van der Ven N. Looman N. Ergun- Al Kafadji S. Dalloyaux O. Sir J. Braspenning C. Fluit W. Kuijer-Siebelink D. van Asselt |
| author_sort | M. van der Ven |
| collection | DOAJ |
| description | Introduction: Older patients with complex care needs are increasingly seen in the emergency department (ED), requiring patient-centered care that involves collaboration among multiple specialists. Inadequate interphysician collaboration (IPhC) can increase the risk of adverse outcomes. Although the ED presents opportunities for learning IPhC, it is unknown how this potential could be exploited. This study examines ED interactions between residents and supervisors caring for hip fracture patients to explore influencing contextual factors and how IPhC (learning) can be improved. Methods: Interactions between residents and supervisors from anesthesiology, emergency medicine, geriatric medicine, trauma, and orthopedic surgery concerning eight hip fractures patients were observed. Thirteen residents and twelve supervisors participated in field interviews to discuss observed behavior. Thematic analysis was conducted on observation notes and interviews. Themes were discussed with participants in four focus groups to reflect on interactions and explore opportunities for improving (learning) IPhC. Results: Residents primarily performed their own tasks with remote supervision. Repeated tasks and contradictory treatment plans were common. Five contextual factors influenced IPhC interactions: swarm of unacquainted professionals, bustling ED environment, lack of coordination, silo mentality, and limited, hierarchical feedback culture. Residents viewed their IPhC interactions as sufficient, despite observed contradictions. In focus groups, participants recognized these issues but were unaware of the associated risks. Conclusion: Interactions in acute care lack coordination and integration. The complex acute care context impedes connectivity between specialties and IPhC learning, which may lead to increased risk of adverse outcomes. To improve IPhC and learning, addressing both contextual aspects and improved role modelling and feedback are needed. |
| format | Article |
| id | doaj-art-1c88cada7bea48d0af89abc3e10668b9 |
| institution | DOAJ |
| issn | 2667-3215 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Qualitative Research in Health |
| spelling | doaj-art-1c88cada7bea48d0af89abc3e10668b92025-08-20T02:56:10ZengElsevierSSM: Qualitative Research in Health2667-32152025-06-01710056610.1016/j.ssmqr.2025.100566The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency departmentM. van der Ven0N. Looman1N. Ergun- Al Kafadji2S. Dalloyaux3O. Sir4J. Braspenning5C. Fluit6W. Kuijer-Siebelink7D. van Asselt8Geriatric Medicine Department, Radboud University Medical Center, Nijmegen, the Netherlands; Corresponding author.Primary & Community Care Department, Radboud University Medical Center, Nijmegen, the NetherlandsGeriatric Medicine Department, Elisabeth Tweesteden Ziekenhuis, Tilburg, the NetherlandsGeriatric Psychiatry Department, Pro Persona, Arnhem, the NetherlandsEmergency Department, Radboud University Medical Center, Nijmegen, the NetherlandsIQ Health, Radboud University Medical Center, Nijmegen, the NetherlandsRadboud University Medical Center Health Academy, Department of Research on Learning and Education, Nijmegen, the NetherlandsHAN University of Applied Sciences, School of Education, Nijmegen, the Netherlands; Radboud University Medical Center Health Academy, Department of Research on Learning and Education, Nijmegen, the NetherlandsGeriatric Medicine Department, Radboud University Medical Center, Nijmegen, the NetherlandsIntroduction: Older patients with complex care needs are increasingly seen in the emergency department (ED), requiring patient-centered care that involves collaboration among multiple specialists. Inadequate interphysician collaboration (IPhC) can increase the risk of adverse outcomes. Although the ED presents opportunities for learning IPhC, it is unknown how this potential could be exploited. This study examines ED interactions between residents and supervisors caring for hip fracture patients to explore influencing contextual factors and how IPhC (learning) can be improved. Methods: Interactions between residents and supervisors from anesthesiology, emergency medicine, geriatric medicine, trauma, and orthopedic surgery concerning eight hip fractures patients were observed. Thirteen residents and twelve supervisors participated in field interviews to discuss observed behavior. Thematic analysis was conducted on observation notes and interviews. Themes were discussed with participants in four focus groups to reflect on interactions and explore opportunities for improving (learning) IPhC. Results: Residents primarily performed their own tasks with remote supervision. Repeated tasks and contradictory treatment plans were common. Five contextual factors influenced IPhC interactions: swarm of unacquainted professionals, bustling ED environment, lack of coordination, silo mentality, and limited, hierarchical feedback culture. Residents viewed their IPhC interactions as sufficient, despite observed contradictions. In focus groups, participants recognized these issues but were unaware of the associated risks. Conclusion: Interactions in acute care lack coordination and integration. The complex acute care context impedes connectivity between specialties and IPhC learning, which may lead to increased risk of adverse outcomes. To improve IPhC and learning, addressing both contextual aspects and improved role modelling and feedback are needed.http://www.sciencedirect.com/science/article/pii/S2667321525000447 |
| spellingShingle | M. van der Ven N. Looman N. Ergun- Al Kafadji S. Dalloyaux O. Sir J. Braspenning C. Fluit W. Kuijer-Siebelink D. van Asselt The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department SSM: Qualitative Research in Health |
| title | The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department |
| title_full | The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department |
| title_fullStr | The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department |
| title_full_unstemmed | The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department |
| title_short | The impact of context on interphysician collaboration and learning: A focused ethnography around hip fracture patients in the emergency department |
| title_sort | impact of context on interphysician collaboration and learning a focused ethnography around hip fracture patients in the emergency department |
| url | http://www.sciencedirect.com/science/article/pii/S2667321525000447 |
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