Located in urban Sydney, at the time of research Hospital A provided a number of differentiated emergency care services including an acute , subacute and emergency medicine unit (EMU) facility; a psychiatric emergency care centre ; and three resuscitation beds.

During our data collection period (spanning 4 months), the emergency department was providing treatment to approximately 130 patients a day. We audio recorded and observed 19 patients’ journeys, conducted semi-structured interviews with 30 clinicians and carried out an additional 65 hrs of observations here. Of the patients we audio recorded, three were over 80 years of age, one was over 70, three were in their 60s, two in their 50s, four were over 40, three over 30 and three were in their 20s. All were English speakers. Several had immigrated to Australia from countries including Sri Lanka, Croatia, Spain, the UK, Lebanon and Iran.

Hospital B , located in a suburban area in northern Sydney, was not a major trauma emergency department, so patients with very serious injuries are frequently diverted to another emergency department within the broader geographic area. It does, however, provide wide ranging services to its community including a “fast track” option for more straightforward patient presentations where no treatment is required (e.g. a change of bandages); a trainee nurse practitioner service ; and an acute and subacute facility. It has two resuscitation beds. There is a psychiatric emergency care centre very close by.

During our data collection period, the emergency department treated 61–100 patients a day. While the patient demography varied in terms of linguistic backgrounds and age, a proportionately large number of elderly patients with multiple co-morbidities presented to this emergency department, many of whom were of an English-speaking background . Our data collection reflects this elderly demographic: of the 17 patient journeys we audio recorded there, four patients were over 80 years old and seven over 60. Ten were female and seven male. We interviewed 20 clinicians, and spent just over 20 hrs carrying out observations.

Located in a major regional hub in New South Wales, at the time of research Hospital C provided the full range of emergency department services, including a fast track option, an acute and subacute facility, and three resuscitation beds. A mental health team is also based within the department.

During the time of our data collection, it was estimated that 120–137 patients presented to this emergency department each day, with 12,666 presentations in the 3 months when we conducted our data collection. Like Hospital B , a large proportion of this emergency department’s patients were over 65 years of age. At the time of research, 67 % of patients were above 60 years, 31 % were in their 60s, 23 % in their 70s and 13 % over 80. Almost all were born in Australia and were of an English-speaking background . At Hospital C , we audio recorded 15 patients’ journeys, interviewed 37 clinicians and spent just over 42 hrs carrying out observations. Of the patients we followed, three were over 80 years in age, eight were over 60, two were over 50 and three were under 50. All were native English speakers.

At the time of research, Hospital D , the major public hospital in the Australian Capital Territory , was a teaching hospital for one of the major medical schools in the region. The emergency department provided a fast track option; a nurse practitioner service ; an acute, subacute and EMU facility; provision for mental health patients ; and three resuscitation beds. During our data collection period, the emergency department received an average of 151 patient presentations each day. The patient demography varied, although once more most were born in Australia and were native English speakers. We recorded 19 patient journeys in this emergency department, and interviewed 34 clinicians. We also conducted 47 hrs of observations. Of the patients we followed, one was over 85, two were over 70, two were over 60, three were over 50, four were over 40, three were over 30 and four were in their 20s. All but three were native English-speakers.

This emergency department was one of the busiest emergency departments in New South Wales and the major trauma centre for southern Sydney at the time of research. It provided a number of differentiated emergency care services including a fast track option; an acute, subacute and EMU facility; a nurse practitioner; a psychiatric emergency care centre ; and three resuscitation beds . During the period we conducted our research here, the hospital received 59,017 trauma presentations. Twenty per cent of these trauma patients were less than 16 years of age. We conducted two rounds of data collection here, over a period of 3 years. During that time, the number of emergency department presentations increased by 19 %. Of the patients we audio recorded, one patient was in their 20s, four were in their 30s, three were over 40 and five were over 80. All were English speakers. In addition, 29 clinicians were interviewed and over 67 hrs of observations were conducted.

Table 1.2 summarises the data collected from each of five hospitals.

Communication (whether spoken, gestured, written or electronic) underpins emergency department practice. From handovers to taking blood , giving medications, talking to patients, listening to colleagues, reading computer screens, and doing resuscitations, clinicians engage in speaking, listening, reading and writing on a continual basis. The ways the communicative, social and clinical practices work together in the complex context of the emergency department define the overall quality of the experience for patients and the ultimate work satisfaction of clinicians. The communicative challenges and risks in emergency departments arise directly from the unique contextual demands of the environment. While the focus of our book is communication, we have integrated this with descriptions of the environment, observations, staffing, teamwork and networks of the emergency department as a means of setting the context for the communicative interactions.

The book therefore offers a systemic and information-rich description and analysis of the complex communication ecology of contemporary emergency departments. The study’s uniqueness lies in its approach: patients have been observed and recorded in conversation with healthcare practitioners and administration staff from the moment they enter the emergency department (at “triage”) until the moment a decision is made about treatment (“disposition”) or release from the emergency department. Our analytic framing has developed an approach to emergency department practice that suggests areas of communicative vulnerability, identifying risk and practices that either increase or diminish risk . Encounters are located within the complex and institutionally governed frameworks of social interactions, relationships and situations specific to the emergency department and the hospital in question.

We consider the ‘taken for granted’ language and communication networks of clinicians in the emergency department and we examine them closely. That is, by focusing on the authentic language and communication practices used in the consultations, we analyse the following communicative dimensions:

We begin this book by providing an overview of the emergency department context, exploring the ways in which the emergency department’s unique context becomes reflected in particular communication practices between patients and clinicians (Chap. 2).