Emergency Physician Use of Cognitive Strategies to Manage Interruptions

• Published in: Annals of emergency medicine Vol. 70; no. 5; pp. 683 - 687
• Main Authors: Ratwani, Raj M., PhD, Fong, Allan, MS, Puthumana, Josh S., BA, Hettinger, Aaron Z., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Cognition; Efficiency, Organizational; Emergency; Emergency Service, Hospital - organization & administration; Humans; Medical Errors - adverse effects; Medical Errors - statistics & numerical data; Medical Staff, Hospital - organization & administration; Patient Safety; Physicians - organization & administration; Physicians - psychology; Task Performance and Analysis; Time and Motion Studies; Workload - psychology; Workload - statistics & numerical data; Workplace - organization & administration; Workplace - statistics & numerical data
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2017.04.036

Study objective The purpose of this study is to examine whether emergency physicians use strategies to manage interruptions during clinical work. Interruption management strategies include immediately engaging the interruption by discontinuing the current task and starting the interruption, continuing the current task while engaging the interruption, rejecting the interruption, or delaying the interruption. Methods An observational time and motion study was conducted in 3 different urban, academic emergency departments with 18 attending emergency physicians. Each physician was observed for 2 hours, and the number of interruptions, source of interruptions, type of task being interrupted, and use of interruption management strategies were documented. Results Participants were interrupted on average of 12.5 times per hour. The majority of interruptions were in person from other staff, including nurses, residents, and other attending physicians. When participants were interrupted, they were often working on their computer. Participants almost always immediately engaged the interruption task (75.4% of the time), followed by multitasking, in which the primary task was continued while the interrupting task was performed (22.2%). Physicians rejected or delayed interruptions less than 2% of the time. Conclusion Our results suggest there is an opportunity to introduce emergency physicians to the use of interruption management strategies as a method of handling the frequent interruptions they are exposed to. Use of these strategies when high-risk primary tasks are performed may reduce the disruptiveness of some interruptions and improve patient safety.