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Review of interruptions in a pediatric subspecialty outpatient clinic
Tyler Lee1, Hinette Rosario2, Elizabeth Cifuentes2
1Philadelphia College of Osteopathic Medicine, Philadelphia, PA, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
Insights
Pediatric clinic visits experience frequent interruptions, primarily from patients during visits with younger children. However, these interruptions showed minimal impact on caregiver satisfaction or communication recall.
Area of Science:
- Pediatric Healthcare
- Clinical Communication
- Patient Experience
Background:
- Interruptions are common in clinical settings, potentially affecting communication dynamics.
- Understanding these disruptions is crucial for optimizing patient care and communication strategies.
Purpose of the Study:
- To characterize interruptions during pediatric ambulatory visits.
- To evaluate the influence of these interruptions on caregiver-reported communication quality, patient satisfaction, and recall of medical instructions.
Main Methods:
- An observational study involving video recording of 81 pediatric gastroenterology clinic visits.
- Interruptions were categorized, and interruption rates were correlated with caregiver satisfaction, communication perception, and instruction recall.
Main Results:
- A total of 675 interruptions were recorded, averaging 7.96 per visit.
- Younger patients (<7 years) experienced higher interruption rates, predominantly 'Pediatric Associated' interruptions.
- Minimal correlation was found between interruption rates and caregiver satisfaction, communication quality perception, or instruction recall.
Conclusions:
- The impact of interruptions on pediatric visits remains uncertain.
- Interruptions might play a role in aligning patient and physician agendas.
- Further research is needed to clarify the effects of interruptions and inform communication training for healthcare providers.
Introduction:
The objective of this study was to describe interruptions in the pediatric ambulatory setting and to assess their impact on perceived physician communication, patient satisfaction and recall of provided physician instructions.
Methods:
An observational study was performed at the Children's Hospital of Philadelphia, Pediatric Gastroenterology clinic. Participation consisted of video recording the clinic visit and the caregiver completed post-visit surveys on communication and satisfaction. Video recordings were coded for interruptions, which were divided into 3 main categories: Visit Associated, Pediatric Associated, and Unanticipated. An interruption rate was calculated and correlated with the following outcome variables to assess the impact of interruptions: caregiver satisfaction, caregiver perception on the quality of physician communication, and caregiver instruction recall.
Results:
There were 675 interruptions noted in the 81 clinic visits, with an average of 7.96 (σ = 7.68) interruptions per visit. Six visits had no interruptions. The Patient was the most frequent interrupter. Significantly higher interruption rates occurred in clinic visits with younger patients (<7 years old) with most of the interruptions being Pediatric Associated interruptions. There was minimal correlation between the clinic visit interruption rate and caregiver satisfaction with the communication, caregiver perception of quality of communication, or caregiver instruction recall rate.
Conclusion:
The effect of interruptions on the pediatric visit remains unclear. Interruptions may be part of the communication process to ensure alignment of the patient's agenda. Additional studies are needed to help determine the impact of interruptions and guide medical education on patient communication.
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