Quantifying Emergency Physician Interruptions due to Electrocardiogram Review
Kimon L H Ioannides1, Daniel James Brownstein2, Andrew J Henreid3
1Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California.
The Journal of Emergency Medicine
|January 8, 2021
Summary
Electrocardiogram (ECG) reviews frequently interrupt emergency physicians, often disrupting electronic health record use. Streamlining ECG review could enhance patient safety by reducing these workflow interruptions.
Area of Science:
- Emergency Medicine
- Healthcare Operations
- Patient Safety
Background:
- Interruptions pose risks to safety and efficiency, particularly in emergency departments (EDs).
- Policies mandating immediate electrocardiogram (ECG) review can increase interruption frequency.
Purpose of the Study:
- To evaluate ECG review as a source of interruptions for emergency physicians.
- To identify opportunities for interventions to mitigate these interruptions.
Main Methods:
- A time-and-motion study observed emergency physicians during clinical shifts.
- Task transitions and ECG review instances, including start/end times, were logged.
- Interruptions were defined as ECG reviews breaking a continuous task.
Main Results:
- ECG reviews occurred at a mean rate of 1.4 per hour, increasing to 2.8 per hour in high-acuity zones.
- Nearly half (48%) of all ECG reviews were interruptions, primarily disrupting electronic medical record use (67%) and in-person communication (18%).
- Most ECG reviews (75%) took less than 30 seconds.
Conclusions:
- ECG review is a significant contributor to emergency physician interruptions.
- Integrating ECG review more seamlessly into workflows may improve patient safety by reducing disruptions.
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