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).


Comments

  1. So, do you have a system with your staff for how and when to interrupt you? I had a similar problem with my pathologist boss when I was a lab tech. I didn’t want to interrupt him unnecessarily but I sometimes needed clarification about the experiment he wanted me to run. Oh, and I needed that information QUICKLY so that there was enough time left in the day to actually run the experiment.

  2. One of the problems, in some places, is the constant requirement for EMS to call for permission for treatments, such as opioids and sedatives. These requirements are interruptions of both the doctor and the medic. This is interfering with patient care on both ends.

    There is no evidence of any benefit to these requirements for on line medical command permission. These requirements just allow medical directors to feel comfortable authorizing dangerous medics to treat patients, Because they have to call to do anything dangerous. As if medics can’t be dangerous with every drug in the bag.

    The way to prevent dangerous medics from harming patients is to prevent dangerous medics from treating patients, not by having a mechanism that permits dangerous medics to treat patients.

    We certainly do not have any shortage of paramedics. The bad ones could always put their triage skills to work in the exciting world of fast food order fulfillment.

    Sorry about going off on a tangent.

  3. Great post. Also, don’t forget about GPs who get bombarded with pharma reps pushing pills

  4. Jamie Davis, the Podmedic says:

    I agree more with the proposition that the reason interrupted tasks were completed faster. I was always amazed how fast we got patients discharged at the end of the shift compared to the rest of the time. It seemed that sense of urgency turned into a rush to wrap up things.

  5. Interruptions happen everywhere. It would certainly be easier to observe them in a more contained environment like the ED.

    My personal approach is to try to set a tone, which I have little doubt causes some feelings that I can be abrupt or unapproachable at times, but I think that’s better than letting yourself get interrupted by anyone and everyone. I may just feel the need to say, “I’m busy right now.” At that point some at least expect you to give them some details about when you will be available, etc., but this too is a cognitive interruption.
    I do try to search the person out after I’m finished with whatever, but even this may be a negotiation. Something short and simple might be done on the spot, but something more involved will require setting aside some time for it.

    The flip side is that when you do manage to sit down with that person, you don’t let others interrupt what’s going on so you can devote your attention to them. Also, you have to accept when someone else doesn’t want to interrupt what they’re doing just for you.

    We live in a time when people have become self-absorbed, expect you to be at their disposal 24/7, whether it’s by phone, or email, or even just passing down the hall. It’s what leads to people never turning off cellphones, feeling compelled to answer them when they go off during an office visit (the percentage of people that have loud, obnoxious ring “songs” is quite astounding).

  6. nurse 1961 says:

    If you can’t handle interruptions don’t work in the Emergency Department. Hense the name, EMERGENCY.

    Interruptions for return phone calls, transfer patients, changes in patient condition, clarification of a order or treatment, and generalized chaos. Which one of these doesn’t cause an interruption.

    If you think the interruptions are bad for the Doc, try being a nurse!!

  7. I work in a noisy environment and so mostly little talking goes on while working, unless you want to shout a lot. However, I have noticed that I can sit and work for a long time and no one wants to “chat” – until I put headphones on, that is. Then my co-workers all transform into “Chatty Cathy”. And they get really po’d when I ignore them.