News Flash: Emergency Physicians frequently interrupted

via CNN, an Australian study on interruptions in the ED:

(CNN) – Interruptions in the emergency room may exact an unhealthy toll on patient care, a group of Australian researchers reported Thursday.

The researchers, from the University of Sydney and the University of New South Wales, found that interruptions led emergency department doctors to spend less time on the tasks they were working on and, in nearly a fifth of cases, to give up on the task altogether.

The researchers carried out a time-and-motion study in the emergency department of a 400-bed teaching hospital, observing 40 doctors for more than 210 hours.

So, an average of 5 hrs observation per doc.  Not bad, but not exactly an average of a full shift for any EM Physician.

They found that each doctor was typically interrupted 6.6 times per hour; 11 percent of all tasks were interrupted, 3.3 percent of them more than once. They calculated time on task and found that physicians spent less time on interrupted tasks than on uninterrupted tasks. In addition, doctors were multitasking 12.8 percent of the time.

That seems low to me, but my thoughts are anecdotal.  Sure, I can spend 30 minutes with no interruptions, then get 3 a minute for what seems like forever.


Other studies have shown that interruptions can result in lapses of attention, memory or perception, they wrote.

“Further, interruptions add significantly to cognitive load, increase stress and anxiety, inhibit decision-making performance and increase task errors,” they said.

Yep.

The interruptions included a doctor being asked a question while trying to write a prescription.

“Now, most people think it’s very acceptable to interrupt,” but doing so can be dangerous, lead author Westbrook said. She urged hospital emergency department directors to teach hospital personnel when it is acceptable to interrupt and when it may be better to find an alternative strategy.

“We really have to look at ways to try and reduce unnecessary interruptions,” she said.

Amen.


On average, doctors completed tasks that were interrupted once in about half the time they would have taken if they had not been interrupted. That perplexed the authors, who speculated that the interruptions led clinicians to try to compensate for the “lost” time by working faster and cutting corners. They said there was a strong need to develop processes that minimize unnecessary interruptions and multitasking.”Our results support the hypothesis that the highly interruptive nature of busy clinical environments may have a negative impact on patient safety,” they said.

Or, they stopped dithering and started making decisions.  We need fewer hypotheses and a specific study.


Other industries have recognized interruptions as dangerous, including the airline industry, which has developed strategies to reduce interruptions to the flight crew during takeoff and limited unnecessary communications with the cockpit.

“In our society, we get very used to interrupting each other,” Westbrook said. “Sometimes we need to stop and think about that.”

Yes, and I’ll agree right now that interruptions work both ways. to and from the doc.  The chaotic environment enables some less than wonderful behaviors, and one of those is a lack of respect for the time of others (people seem to like to talk to me while I’m working on the computer, when I need the most concentration, but I’m quiet and still, and therefore I’m chatted up).

All of us in the ED could do a better job on stifling interruptions, we need to focus on those times when we should not have any interruptions, and change behaviors from there (realizing that culture eats strategy every day).