Interruptions in emergency department work: an observational and interview study

Area of Science:

• Healthcare delivery
• Clinical workflow analysis
• Patient safety research

Background:

• Frequent interruptions in healthcare settings are hypothesized to impair clinicians' working memory, potentially leading to medical errors and compromising patient safety.
• Understanding the nature and frequency of interruptions is crucial for developing strategies to mitigate risks in high-pressure environments like emergency departments.

Purpose of the Study:

• To investigate the types, frequency, and context of interruptions experienced by clinicians in emergency departments.
• To explore clinicians' perceptions of these interruptions and their impact on work processes.

Main Methods:

• Direct observation of 18 clinicians (licensed practical nurses, registered nurses, and medical doctors) in two Swedish emergency departments for 2 hours each.
• Post-observation semistructured interviews to gather perceptions of interruptions.
• Analysis of data using non-parametric statistics and quantitative/qualitative content analysis.

Main Results:

• An interruption rate of 5.1 interruptions per hour was recorded.
• Clinicians were most frequently interrupted during information exchange activities, with medication preparation being the most interrupted activity (28.6%).
• Face-to-face interactions (51%) at nurses' and doctors' stations (68%) were common interruption methods, with medical doctors being interrupted most often.

Conclusions:

• Interruptions are prevalent during information exchange, with medication preparation posing a potential risk for errors.
• Clinicians' perceptions of interruptions are often negative when they disrupt work processes, highlighting the need for workflow optimization.