Interruptions Potentially Linked to ED Medical Errors
Monday, July 11, 2011
Emergency department (ED) physicians are faced with enough pressure trying to solve medical urgencies and save lives. Toss in multiple interruptions causing task changes during their shifts, and the potential of errors increases.
A recent study by researchers at the University of Indiana found some significant results when they observed 85 academic and community hospital ED physicians during their shifts.
These findings, published in the Annals of Emergency Medicine, state that in a normal two-hour period, an academic ED physician might treat as many as 16 patients simultaneously and also interact with as many as 132 individuals. ED physicians in a community hospital setting treat as many as 12 patients at the same time and interact with as many as 101 individuals concurrently.
Researchers divided ED physician tasks into work units as small as 30 seconds, determining that the majority of these emergency medical professionals’ activities are spent on indirect patient care, such as charting, reviewing medical records, interacting with consultants, and interpreting tests. In an academic setting, ED physicians spent a median of 64 minutes on indirect patient care, while ED physicians in a community hospital spent a median amount of 55 minutes. Researchers were surprised at the lack of time ED physicians were actually able to spend in direct patient interaction or physically examining patients.
Uncovering Interruptions
During the two-hour period researchers observed academic and community hospital ED physicians, they found the number of interruptions the emergency medical professionals faced significant. Community hospital physicians faced up to 19 per two-hour period with a median of six, while academic physicians experienced 32 interruptions with a median of 12.
Regarding time devoted to direct patient care, a time range from between only one to 13 minutes with a median of six minutes was found for academic medical centers, while community hospitals acquired a range that was between zero to 20 minutes, with a median of seven minutes.
The findings suggest that these interruptions could be contributing to medical errors. If an ED physician is interrupted during his or her routine duties of taking care of multiple patients with emergent needs, it causes the physician to change tasks, pause in mid-thought or action or sometimes even leave tasks unfinished. In conjunction with the high-pressure atmosphere of an ED, unintentional medical errors may result.
While some interruptions in the ED are unavoidable, this research brings to light an issue not typically investigated or measured. Physicians and patients alike could benefit from further research into the causes of — and solutions to — interruptions in the ED.
MD News July 2011