How do emergency physicians and nurses spend their time in the emergency department?

Hollingsworth, John C.; Chisholm, Carey D.; Giles, Beverly K.; Cordell, William H.; Nelson, D.R.

doi:10.1016/s0196-0644(94)80318-8

Cited by 15 publications

(17 citation statements)

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“…The list of activities has been expanded from the initial selfreported list of activities and illustrates the usefulness of hybridization. The activities identified in this study are similar to those reported by Hollingsworth, Chisholm, Giles, Cordell, and Nelson [33]. The initial list of activities for this study has been updated to include some new activities such as interacting with technology, addressing safety issues, delegating tasks, leaving the unit, and delineating clinician communication patterns.…”

Section: Hierarch Of Activitiessupporting

confidence: 61%

Towards a hybrid method to categorize interruptions and activities in healthcare

Brixey

Robinson

Johnson

et al. 2007

International Journal of Medical Informatics

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SummaryObjective-Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular and for improving healthcare quality and patient safety in general.Method-The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory.Results-The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case.Conclusions-Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

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Section: Hierarch Of Activitiessupporting

confidence: 61%

Towards a hybrid method to categorize interruptions and activities in healthcare

Brixey

Robinson

Johnson

et al. 2007

International Journal of Medical Informatics

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“…24 The mean and median times from triage to discharge for patients in our chart review were 180 and 144 minutes, respectively. Given that approximately one-third of ED visit duration involves direct patient care, 25,26 there is a significant amount of time available for interventions when patients are waiting in triage or examination rooms. Educational interventions are most beneficial when also providing safety devices, as demonstrated in randomized trials where providing home safety devices 10 and booster seats 12 were significantly more effective in knowledge and behavior change compared to education-only interventions.…”

Section: Discussionmentioning

confidence: 99%

Emergency Physicians’ Knowledge and Provision of Child Passenger Safety Information

Zonfrillo

Nelson

Durbin

2011

Academic Emergency Medicine

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Objectives: While physicians provide discharge instructions to patients and families following emergency department (ED) visits, injury prevention information may not be routinely included in these instructions. This study assessed emergency physicians' knowledge and provision of child passenger safety (CPS) information to patients following motor vehicle crashes (MVCs).Methods: This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution. Members of the American Academy of Pediatrics (AAP) Section on Emergency Medicine were invited to participate in the survey. Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations. The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home.Results: There were 317 survey respondents from 1,024 eligible physicians, of whom 43 began but did not complete the survey. The data analyzed are from the 274 who completed the survey. While 85% (95% confidence interval [CI] = 81% to 89%) of physicians believed that CPS information should be included in discharge instructions, only 36% (95% CI = 31% to 42%) correctly answered all knowledge questions. Of the 51 self-identified division ⁄ department chiefs, 15 (29.4%; 95% CI = 16.9% to 41.9%) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs. For the medical record review, of the 152 randomly selected MVC visits, 13 (8.6%; 95% CI = 4.1% to 13.0%) had documented CPS information in the discharge instructions. Patients with documented CPS information were younger, but there were no significant differences in race, sex, or maximum abbreviated injury scale score between patients with versus without CPS information. Conclusions:While emergency physicians value the use of CPS information in discharge instructions following MVCs, they do not have adequate knowledge of, nor do they regularly disseminate, this information.

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“…[4][5][6] Recent studies have found that physicians spend more time on electronic documentation than providing direct patient care, 2,7-11 and other studies have reported that clinical computer work constitutes the highest proportion of time spent by physicians. [12][13][14][15] The majority of studies were based on subjective reporting by physicians or other observers, limiting their validity. A recent study raised concerns about errors in subjective reporting.…”

Section: Introductionmentioning

confidence: 99%

Racing Against the Clock: Internal Medicine Residents' Time Spent On Electronic Health Records

Chen

Guo

Illipparambil

et al. 2016

Journal of Graduate Medical Education

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How do emergency physicians and nurses spend their time in the emergency department?

Cited by 15 publications

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Towards a hybrid method to categorize interruptions and activities in healthcare

Towards a hybrid method to categorize interruptions and activities in healthcare

Emergency Physicians’ Knowledge and Provision of Child Passenger Safety Information

Racing Against the Clock: Internal Medicine Residents' Time Spent On Electronic Health Records

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