Good Interdepartmental Relationships: The Foundations of a Solid Emergency Department

  • Frank J. Edwards Program Director, Emergency Medicine Residency, Arnot Ogden Medical Center, Elmira, New York, USA.


“No man is an island” said the English poet, John Donne, and nowhere can that statement be better appreciated than in a modern emergency department (ED). As emergency physicians, we work in the setting of a close knit team involving nurses, technicians, consultants, clerks, security guards and many more. On a macroscopic level as well, the ED itself needs productive relationships with every other department in the hospital. Back when the ED was staffed by physicians-in-training, general practitioners and moonlighting specialists, the care of patients was jealously divided between the long-entrenched traditional specialties. Anesthesiologists handled difficult airways; Surgeons took care of trauma; Radiologists did the ultrasounds and read all the films, and so forth. Emergency medicine—a specialty that encompassed parts of many disciplines—was initially met with skepticism and resistance from the traditional fields.  

I have been in practice long enough to remember when anesthesiologists fought against emergency physicians doing RSI and how they tried to stop us from using propofol or ketamine for procedural sedation. Orthopedists wanted to be consulted before we reduced a shoulder. Surgeons got angry if you gave morphine to a belly pain patient. In the early 1990’s at the University of Rochester, my colleague, Dr. Steve White, had to sneak into the ED with his own portable ultrasound device (with its postage stamp sized screen), because to have done so openly would have brought down the wrath of radiologists who believed that ultrasonography belonged to their department alone.

These turf battles are mostly a thing of the past, thanks to clinical studies conducted by our specialty that proved what we can and should do. But challenges regarding interdepartmental relationships still remain. In the following discussion we will look at current friction points between the ED and other departments, including radiology, anesthesia, surgery, obstetrics/gynecology, cardiology, and the internal medicine admitting services.


Download data is not yet available.


1. Safari S, Baratloo A, Negida AS, Sanei Taheri M, Hashemi B, Hosseini Selkisari S. Comparing the Interpretation of Traumatic Chest X-Ray by Emergency Medicine Specialists and Radiologists. Arch Trauma Res. 2014;3(4):e22189.
2. Mates J, Branstetter BF, Morgan MB, Lionetti DM, Chang PJ. ‘Wet Reads’ in the Age of PACS: Technical and Workflow Considerations for a Preliminary Report System. J Digit Imaging. 2007;20(3):296-306.
3. Bushra JS, McNeil B, Wald DA, Schwell A, Karras DJ. A comparison of trauma intubations managed by anesthesiologists and emergency physicians. Acad Emerg Med. 2004;11(1):66-70.
4. Green SM, Krauss B. Who owns deep sedation? Ann Emerg Med. 2011;57(5):470-4.
5. Ramarajan N, Krishnamoorthi R, Barth R, Ghanouni P, Mueller C, Dannenburg B, et al. An interdisciplinary initiative to reduce radiation exposure: evaluation of appendicitis in a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography pathway. Acad Emerg Med. 2009;16(11):1258-65.
6. Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY. Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. 2009;53(6):701-10.e4.
7. Chang A, Sanjeevan I, Jennings E, Watts P, Whellan D, Hollander J. 107EMF Jefferson Emergency Department/Observation Unit Telehealth Transition of Care for Heart Failure (JETT-HF): A Determination of Patient Needs. Ann Emerg Med. 2017;70(4):S43-S4.
8. Spaite DW, Bartholomeaux F, Guisto J, Lindberg E, Hull B, Eyherabide A, et al. Rapid process redesign in a university-based emergency department: decreasing waiting time intervals and improving patient satisfaction. Ann Emerg Med. 2002;39(2):168-77.
9. O'Donovan TR. The management and leadership role of the emergency physician: some intrahospital relationships. Jacep. 1977;6(10):458-61.
How to Cite
Edwards F. Good Interdepartmental Relationships: The Foundations of a Solid Emergency Department. Adv J Emerg Med. 2(2):e14.