Physician Interruptions in the Emergency Department

1. Physician Interruptions in the Emergency Department Puja Vyas Rebecca Zambon Advisor: Dr. Dan France

2. Purpose • Problem: Increasing number of patient complaints in the Emergency Department (ED) due to inefficient care and lack of interaction with ED physicians • One major area of interest is the study of interruptions and their effect on patient care. • Objective: To examine the types and frequencies of physician interruptions in the Vanderbilt University Emergency Department

3. Vision • An ideal ED would: • Maximize time spent with patients • Minimize interruptions • Reduce patient complaints • More effective communication • Thus, maximum efficiency

4. Important Terms • An interruption is an event that takes the physician’s attention away from the task at hand for less than 20 seconds but does not change the physician’s activity. • A break in task is an event that takes the physician’s attention away from a task for more than 20 seconds resulting in a change of activity.

5. Methodology • Literature Review • Observe the VU ED • Create a form that allows multiple users to standardize observations. • Repeat observations in VU ED

6. From the Literature Review • In various studies, it was found that: • 32% of physician’s time was spent on direct patient care, 47% on indirect patient care, mostly charting, and 21% on non-patient care.1 • 1/3 of all communication events occurred from interruptions, and 1/10 of communication entailed two or more simultaneous conversations. Only 12.7% of conversations dealt with formal patient information. 82% of communication was face-to-face.2 From:1 Coiera, Enrico W., et al. “Communication loads on clinical staff in the emergency department.” Medical Journal of Australia Vol 176 (2002): 415-418., and 2Hollingsworth, Jason C., et al. “How do Physicians and Nurses Spend Their Time in the Emergency Department?” Annals of Emergency Medicine 31.1 (1998): 87-91.

7. Observations • First Observation: Patient flow as explained by Dr. Robin Hemphill • Second Observation: Monitored stations to get a general idea of inner workings of ED • Subsequent Observations: Shadowed physicians and noted distractions in order to develop standardized form

8. Patient Flow in the VU ED

9. Standardized Form

10. Data Overview

11. Results – Interruptions during Tasks Table 1 illustrates the percentage of the time spent on each task and the percentage of distractions that occur during that task.

12. Results – Interruption Types Table 2 illustrates the types of interruptions that occur and the percentage of their occurrence.

13. Recommendations • Separate room for charting • minimize distractions • Computerized charting system • Prevents loss of charts • Improves legibility • Saves time • More information on whiteboard • Include radiology information