# Navigating the Emergency Department: A Qualitative Study on Resident Doctors’ Insights Into an Electronic Emergency Department Handbook

## TL;DR

This study explores how an electronic handbook helps new doctors in the UK emergency department by boosting confidence and efficiency during their training.

## Contribution

The study provides novel insights into the use of a locally tailored electronic handbook for resident doctors in a UK emergency department.

## Key findings

- The handbook reduced induction overload and clarified expectations for new doctors.
- It improved access to local protocols and referral pathways, enhancing decision-making and confidence.
- International medical graduates reported the most significant confidence gains from using the handbook.

## Abstract

Background

Resident doctors entering Emergency Medicine (EM) face heavy workloads, rapid decision-making demands, and variable access to local protocols. While electronic handbooks show promise in other specialties, evidence from emergency departments (EDs) in the United Kingdom is limited. This study evaluated an electronic ED handbook’s impact on confidence and knowledge among new ED doctors at a District General Hospital.

Methods

Using an interpretivist qualitative design, we conducted semi-structured interviews with purposively sampled 15 resident doctors (Foundation Year 2 (FY2), clinical fellows, general practitioner (GP)/EM trainees), all of whom had used the handbook during induction at Queen Elizabeth Hospital, King’s Lynn (QEHKL), United Kingdom. Interviews (~20 minutes) were conducted by an EM registrar with training in quality improvement and research. These interviews were audio-recorded, transcribed verbatim and pseudonymised, and then analysed using reflexive thematic analysis following Braun and Clarke’s six-phase approach.

Results

Six themes emerged: (i) Orientation and Transition Support - reduced induction overload and clarified expectations, (ii) Rapid Access to Local Protocols and Referral Pathways - single-point access to SDEC, stroke, urology and paediatric pathways, (iii) Decision-Making, Safety and Confidence - bedside guidance for acute coronary syndrome (ACS), head injury, venous thromboembolism (VTE)/deep vein thrombosis (DVT), burns and paediatrics, (iv) Efficiency and Workflow - less time searching intranet, smoother external referrals, (v) Usability and Accessibility - intuitive hyperlinks and mobile use, and (vi) Information Reliability and Maintenance - need for timely updates, fixing broken links and governance. Confidence gains were most pronounced among international medical graduates. All participants recommended the handbook for future cohorts.

Conclusion

The electronic ED handbook appeared to support resident doctors during their transition into EM by enhancing confidence, preparedness, and workflow efficiency. These findings offer useful exploratory insight into how a locally tailored digital tool can assist clinicians early in their ED placement. However, as a qualitative study conducted in a single centre, the results reflect participant perceptions rather than objective outcomes. Future multi-centre or mixed-methods research would be valuable to examine broader applicability and assess measurable effects on practice and patient care.