Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department

Blocker, Renaldo C.; Heaton, Heather A.; Forsyth, Katherine L.; Hawthorne, Hunter J.; El-Sherif, Nibras; Bellolio, M. Fernanda; Nestler, David M.; Hellmich, Thomas; Pasupathy, Kalyan S.; Hallbeck, M. Susan

doi:10.1016/j.jemermed.2017.08.067

Cited by 42 publications

(41 citation statements)

References 18 publications

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“…A previous investigation into ED physicians' decision-making revealed that particularly notions of priority were essential for task-scheduling decisions [47]. Consequently, if ED physicians tend to attend longer to high-priority interruptions, eventually, this may trigger more multitasking episodes [48].…”

Section: Discussionmentioning

confidence: 99%

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Augenstein

Schneider

Wehler

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA). Methods Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2). Results ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009). Conclusions Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.

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Section: Discussionmentioning

confidence: 99%

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Augenstein

Schneider

Wehler

et al. 2021

Scand J Trauma Resusc Emerg Med

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“…In addition to reducing D2B time for high probability cases, this would have the added benefit of reducing alarm fatigue and interruptions in a specialty where interruptions to clinical work already occur at a startlingly high frequency. [32][33][34][35] Alternatively, paramedics could activate the CCL, then transmit the ECG for physician read to potentially cancel the activation, or simply for documentation purposes. The decision whether to transmit high probability cases, allow paramedic activation of the CCL, or a combination of both, will depend heavily on regional practice variations and the relationships between EMS, the ED, and interventional cardiology.…”

Section: Discussionmentioning

confidence: 99%

A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction

Goebel

Vaida

Kahn

et al. 2019

Prehosp. Disaster med.

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Introduction:ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) activation.Hypothesis:An algorithmic approach is proposed to stratify binary STEMI computerized ECG interpretations into low, intermediate, and high STEMI probability tiers.Methods:Based on previous literature, a four-criteria algorithm was developed to rule out/in common causes of prehospital STEMI false-positive computer interpretations: heart rate, QRS width, ST elevation criteria, and artifact. Prehospital STEMI cases were prospectively collected at a single academic center in Salt Lake City, Utah (USA) from May 2012 through October 2013. The prehospital ECGs were applied to the algorithm and compared against activation of the CCL by an emergency department (ED) physician as the outcome of interest. In addition to calculating test characteristics, linear regression was used to look for an association between number of criteria used and accuracy, and logistic regression was used to test if any single criterion performed better than another.Results:There were 63 ECGs available for review, 39 high probability and 24 intermediate probability. The high probability STEMI tier had excellent test characteristics for ruling in STEMI when all four criteria were used, specificity 1.00 (95% CI, 0.59-1.00), positive predictive value 1.00 (0.91-1.00). Linear regression showed a strong correlation demonstrating that false-positives increased as fewer criteria were used (adjusted r-square 0.51; P <.01). Logistic regression showed no significant predictive value for any one criterion over another (P = .80). Limiting physician overread to the intermediate tier only would reduce the number of ECGs requiring physician overread by a factor of 0.62 (95% CI, 0.48-0.75; P <.01).Conclusion:Prehospital STEMI ECGs can be accurately stratified to high, intermediate, and low probabilities for STEMI using the four criteria. While additional study is required, using this tiered algorithmic approach in prehospital ECGs could lead to changes in CCL activation and decreased requirements for physician overread. This may have significant clinical and quality implications.

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“…High urgency medical treatment may lead to fragmentation of production processes. Indeed, observational evidence suggests that physicians in hospital specialties that deal with many urgent cases, such as emergency physicians, often report high numbers of work interruptions [12,13], which might cause inefficiencies. In addition, high urgency cases must often be prioritized over low urgency ones when it comes to allocating scant or occupied resources, such as personnel or operating room capacity.…”

Section: Introductionmentioning

confidence: 99%

Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market

Schneider¹,

Oppel²,

Schreyögg³

2020

Health Care Manag Sci

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With hospital budgets remaining tight and healthcare expenditure rising due to demographic change and advances in technology, hospitals continue to face calls to contain costs and allocate their resources more efficiently. In this context, efficiency has emerged as an increasingly important way for hospitals to withstand competitive pressures in the hospital market. Doing so, however, can be challenging given unpredictable fluctuations in demand, a prime example of which are emergencies, i.e. urgent medical cases. The link between medical urgency and hospitals’ efficiency, however, has been neglected in the literature to date. This study therefore aims to investigate the relationship between hospitals’ urgency characteristics and their efficiency. Our analyses are based on 4094 observations from 1428 hospitals throughout Germany for the years 2015, 2016, and 2017. We calculate an average urgency score for each hospital based on all cases treated in that hospital per year and also investigate the within-hospital dispersion of medical urgency. To analyze the association of these urgency measures with hospitals’ efficiency we use a two-stage double bootstrap data envelopment analysis approach with truncated regression. We find a negative relationship between the urgency score and hospital efficiency. When testing for non-linear effects, the results reveal a u-shaped association, indicating that having either a high or low overall urgency score is beneficial in terms of efficiency. Finally, our results reveal that higher within-hospital urgency dispersion is negatively related to efficiency.

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Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department

Cited by 42 publications

References 18 publications

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction

Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market

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