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 2014 BMJ Quality and Safety
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 Type:||Refereed Article|
|Research Division:||Health Sciences|
|Research Group:||Health services and systems|
|Research Field:||Health care administration|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Evaluation of health outcomes|
|UTAS Author:||Iedema, R (Professor Rick Iedema)|
|Web of Science® Times Cited:||25|
|Deposited By:||Health Sciences B|
Repository Staff Only: item control page