Patient Safety: a tri-stratal interpretation of communicative risk in the Emergency Departments of public hospitals

This paper draws on a major ARC study which investigates the spoken communication between patients and clinicians in the emergency departments of 5 teaching hospitals in and around Sydney, Australia, over a three-year period. In this paper, we examine the complexities of the communication, focusing particularly on the exchanges we identify as potential risk moments; those communicative moments that pose the greatest potential threat to both patient safety and to the overall quality of the patient journey. These potential risk moments (PRMs) can be located metafunctionally in terms of clinician language choices; textually (e.g. signposting of important information and lexical selections) and interpersonally (e.g. questioning strategies and patient narrative tracking skills). Stratally, these PRMs are analysed lexicogrammatically, semantically and also contextually, in terms of some of the factors specific to teaching hospital Emergency Departments.