Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department

Renaldo Blocker, Heather A. Heaton, Katherine L. Forsyth, Hunter J. Hawthorne, Nibras El-Sherif, Fernanda Bellolio, David M. Nestler, Thomas R. Hellmich, Kalyan S Pasupathy, Susan Hallbeck

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: It is unclear how workflow interruptions impact emergency physicians at the point of care. Objectives: Our study aimed to evaluate interruption characteristics experienced by academic emergency physicians. Methods: This prospective, observational study collected interruptions during attending physician shifts. An interruption is defined as any break in performance of a human activity that briefly requires attention. One observer captured interruptions using a validated tablet PC-based tool that time stamped and categorized the data. Data collected included: 1) type, 2) priority of interruption to original task, and 3) physical location of the interruption. A Kruskal-Wallis H test compared interruption priority and duration. A chi-squared analysis examined the priority of interruptions in and outside of the patient rooms. Results: A total of 2355 interruptions were identified across 210 clinical hours and 28 shifts (means = 84.1 interruptions per shift, standard deviation = 14.5; means = 11.21 interruptions per hour, standard deviation = 4.45). Physicians experienced face-to-face physician interruptions most frequently (26.0%), followed by face-to-face nurse communication (21.7%), and environment (20.8%). There was a statistically significant difference in interruption duration based on the interruption priority, χ2(2) = 643.98, p < 0.001, where durations increased as priority increased. Whereas medium/normal interruptions accounted for 53.6% of the total interruptions, 53% of the interruptions that occurred in the patient room (n = 162/308) were considered low priority (χ2 [2, n = 2355] = 78.43, p < 0.001). Conclusions: Our study examined interruptions over entire provider shifts and identified patient rooms as high risk for low-priority interruptions. Targeting provider-centered interventions to patient rooms may aid in mitigating the impacts of interruptions on patient safety and enhancing clinical care.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - 2017

Keywords

  • Human factors
  • Interruptions
  • Patient safety
  • Workflow

ASJC Scopus subject areas

  • Emergency Medicine

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