Patient narratives in the emergency department: A mixed methods study of clinician perceptions.

Abstract

Patient narratives (PNs), documented patient stories in the medical record, are associated with improved communication, enhanced patient-clinician understanding, and greater clinician meaning and purpose. Because the clinical pace of the emergency department (ED) can make it difficult to establish meaningful patient-clinician relationships, we sought to evaluate the feasibility of implementing a PN program in the ED, explore clinicians' perceptions of its impact, and identify the content of ED PNs. We conducted a convergent parallel mixed methods study in a tertiary care ED. Patient eligibility determination (clinically stable with anticipated admission), enrollment, and interview were completed by physicians. Participant narratives were collected at bedside and developed into a narrative note. ED clinicians completed surveys after reading PNs, and narratives underwent content analysis. Twenty-six patients completed PNs and 43 clinicians completed the survey (78%). Clinicians tended to be female (63%), white (91%), and an attending physician (40%) or nurse (30%). The majority perceived the PNs to be therapeutically validating (84%), a good use of clinical time (79%), and helpful in providing emergency care (72%). Clinicians reported that PNs also fostered clinician empathy (84%) and an improved understanding of patients' physical conditions (84%) and perspectives (96%), without inducing emotional stress (75%). The most frequent PN topic was family and friends (32%), followed by health care experience (20%) and career (14%). ED clinicians perceived that PNs enhanced their understanding of patients' lives, values, and perspectives within the context of illness, fostering empathy and supporting more humanistic, patient-centered care. Embedding brief PNs into ED workflows may support patient-clinician communication and clinician experience without disrupting clinical care.