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Creating spaces in intensive care for safe communication: a video-reflexive ethnographic study


Hor, S-Y and Iedema, R and Manias, E, Creating spaces in intensive care for safe communication: a video-reflexive ethnographic study, BMJ Quality and Safety, 23, (12) pp. 1007-1013. ISSN 2044-5415 (2014) [Refereed Article]

Copyright Statement

Copyright 2014 BMJ Quality and Safety

DOI: doi:10.1136/bmjqs-2014-002835


Background: The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins.

Methods: We report on an interventionist video-reflexive ethnographic (VRE) study that explored how clinicians used the built environment to achieve safe communication in an intensive care unit (ICU) in a metropolitan Sydney hospital. We conducted 40 semistructured interviews, 5 weeks of observation and four reflexive focus groups with a total of 87 participants (including medical, nursing, allied health and clerical staff).

Results: We found that the accessibility of staff and patients in the open spaces of the ICU was both a safety feature and a safety risk, enabling safe communication flow, but also allowing potentially unsafe interruptions. Staff managed interruptions while allowing for a safe degree of accessibility by creating temporary protected spaces, using physical markers such as curtains, tape and signs as well as behavioural cues, movement and the development of policies restricting activities at certain areas. Furthermore, clinicians were able to use the VRE method to gain insight into their own practices and problems, and to develop meaningful solutions for other problematic spaces.

Conclusions: ICU staff enable safe communication in their wards by creating temporary spaces that are both 'connected' and 'protected'. The flexibility of these 'soft' strategies is especially well suited to the fast-paced clinical context of intensive care.

Item Details

Item Type:Refereed Article
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health care administration
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Iedema, R (Professor Rick Iedema)
ID Code:98316
Year Published:2014
Web of Science® Times Cited:34
Deposited By:Health Sciences B
Deposited On:2015-02-11
Last Modified:2017-11-06

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