Physician interruptions and workload during emergency department shifts

Interruptions in the Emergency Department (ED) are moderately studied in regard to their impact on physicians' workload. This study captured interruptions characteristics and measures of workload. Twenty-eight ED physicians were followed during their shifts; interruptions they faced were captured using a validated tablet PC-based tool. At the mid and end of their shift, providers completed a NASA-Task Load Index (TLX) questionnaire and a reaction time task. Descriptive statistics and ANOVA were used to identify relationships between physicians' interruptions and workload. A total of 2355 interruptions were identified (M =84.1, SD =14.5). The NASA-TLX results showed increase in physicians' responses for all subscales from mid to end-shifts. Reaction time was higher at end-shift with mean difference of 33.75ms, 95% CI [20.35, 47.13], p < 0.001. At end-shift, there was a statistically significant positive correlation between reaction time and all NASA-TLX subscales. Interruption duration rather than frequency correlated positively with NASA-TLX scores. High/critical interruptions were the least frequent but had longer duration and greater impact on workload. This study provided a unique examination of interruptions over an entire provider shift and identified interruptions as potential causes of increased workload for ED physicians.