The impact of context on interphysician collaboration and learning

A focused ethnography around hip fracture patients in the emergency department

Bibliographic Data

ID21258076
AuthorsM van der Ven (0000-0002-3823-7551, corresponding author), N Looman (0000-0003-2104-6449, Radboud University Nijmegen), N Ergun-Al Kafadji, S Dalloyaux (Pro Persona), Özcan Sir (0000-0002-2990-7971, Radboud University Nijmegen), J Braspenning (Radboud University Nijmegen), Christiaan Fluit (Radboud University Nijmegen), Wietske Kuijer‐Siebelink (0000-0001-7009-3378, HAN University of Applied Sciences), W Kuijer-Siebelink, Dieneke Van Asselt
Year2025
Volume7
Pages100566
Publication date2025-06-01
Open AccessYes
TypeARTICLE
VenueSSM - Qualitative Research in Health (JOURNAL)
Journal identifiersISSN: 2667-3215 • E-ISSN: 2667-3215
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.ssmqr.2025.100566
OpenAlexW4410083481
LanguageEN
References cited43

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

Emergency department · Ethnography · Hip fracture · Medical education · Medical emergency · Osteoporosis · Sociology · Anthropology · Chronic Disease Management Strategies · Emergency and Acute Care Studies · Hip and Femur Fractures · History · Medicine · Nursing · Psychology · Internal Medicine

Tools

Open DOIOpen Access