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Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety
  1. Linda M Isbell,
  2. Julia Tager,
  3. Kendall Beals,
  4. Guanyu Liu
  1. Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
  1. Correspondence to Dr Linda M Isbell, Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; lisbell{at}


Background Emergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers’ reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care.

Methods Ninety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data).

Results Providers generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care.

Conclusions Positive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions.

  • emergency department
  • attitudes
  • diagnostic errors
  • mental health
  • patient safety
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  • Contributors LMI designed and managed the project. GL developed the Qualtrics program for data collection. Quantitative data were analysed by LMI and GL. All authors analysed the qualitative data; coding of qualitative data was led by JT and KB. LMI drafted the manuscript and all authors contributed to revising, editing and finalising the manuscript. All authors approved the final version of the manuscript.

  • Funding This project was funded by the Agency for Healthcare Research and Quality (AHRQ; grant number R01HS025752), US Department of Health and Human Services (HHS) awarded to LMI.

  • Disclaimer The authors are solely responsible for this document’s contents, findings and conclusions, which do not necessarily represent the views of the AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of HHS.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board at the University of Massachusetts Amherst approved this study (protocol number 2016-3291).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data generated for this study include confidential and sensitive information in the form of written patient encounter descriptions and reports of clinical behaviours. These data are not available for sharing.

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