Table 2.

Representative Quotations From Focus Groups

Inherent qualities of the ED	“The busier the ED the less swarming, so early shifts or later in your overnight shift I find myself swarming but if it's mid shift and it's crazy, you can't find everybody to swarm at the same time.” (attending/fellow) “The swarming is great, and I believe it should continue, but I just don't know if it's possible to swarm on every patient, because it's just not practical. It gets busy, and there's more than one of us usually at a station … The attending can't be in both places at the same time.” (resident)
System implementation	“There are a lot of residents, it's hard for us to continue to orient people to the swarm, it's also something that's changing, and so there are a lot of residents who don't understand that the beginning and point of the swarm is to get the initial, I call it the primary survey of the visit. It's not to do everything.” (attending/fellow) “And when we first started this process as well, everyone was very diligent … I think it's just we've gotten, in the year, we've gotten away from both the logistics of it and then also the way in which we're approaching the assessment.” (nurse)
Variability	“It depends on the time of day, depends on the physician, the nurse, depends on the patient.” (nurse) “I also haven't seen it consistently done. It depends on how busy it is, it also depends on the attending you work with. I think some do it more than others.” (resident) “I like that variability. And I don't know if it's necessarily the intent, but the practicality makes it so, and I think it kind of addresses your autonomy vs. learning from mentorship and watching your attending.” (resident)
Efficiency vs. education	“I've been told that [residents] like how we talk to families, like even in a difficult patient setting or family interaction, even just what they need to do to follow up or reasons to come back. So, they have said they like that component of the swarm, seeing how we manage the patient differently than they would.” (attending/fellow) “From a resident education perspective, we are being taught to actually think like emergency medicine physicians.” (resident) “The focus of my education is still more on the recognition and … less so the efficiency and the throughput part of it, so maybe sometimes that's the down side I see at my point of training, like having that opportunity to see the patient by myself and kind of think through it, rather than how fast we can get through it.” (resident)
Outcomes	“And we can get things started, we don't have to now wait for orders, things are much more timely.” (nurse) “Patients seem happier because they're being seen faster, and they don't have to repeat their story over and over again to multiple people.” (resident) “I really appreciate the communication we have with the nursing staff in this model.” (resident)