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

Purpose n Problem: Increasing number of patient complaints in the ED due to inefficient care and lack of interaction with ED physicians n Objective: To examine physician interruptions and the effects of those interruptions on patient care in the Vanderbilt University Emergency Department

Interruptions n An interruption is an event that takes the physician’s attention away but does not change the physician’s activity. n A break in task is an event that takes the physician’s attention away resulting in a change of activity. n We hypothesize that breaks in task are more likely to lead to system errors.

Plan of Action n Literature Review n Observe the VU ED n Create a Taxonomy of Interruptions n Use the taxonomy in further observations n Survey ED staff

First Observation of ED n We completed our first observation on 1/21/03. n Dr. Robin Hemphill, an attending in the VU ED, introduced us to the department and explained the basics of patient flow. n She talked about different organizational systems that are used, such as the triage system, the charting procedure, and the whiteboard where patient data is kept.

Patient Flow in the VU ED

Second Visit to the ED n Performed on 2/13/03 n We sat at two different stations and observed. n From observing this way twice, we have concluded that this is NOT an efficient way to observe. We weren’t sure what the staff was doing, what they were supposed to be doing, what was interrupting them, etc. From one station, for example, the staff was only charting, making phone calls, dictating, etc. This does not give an accurate representation of how time is spent in the ED.

Third Observation - RZ n Observed 3 rd year Resident Very few interruptions Long wait times to get orders approved by attendings Long waits for nurses to carry out orders

Third Observation - PV Observed an Attending Significantly more interruptions Significantly higher no. of patients High incidence of phone tag

Plans for Future Visits n We plan to shadow twice more. n With Scott and Dr. France’s observations, a fairly accurate representation of how time is spent in the VU ED and the interruptions that lead to system errors will be determined.

Interruption Taxonomy n A taxonomy is a division of a topic into ordered groups or categories. n For this project, it will be used as a gauge to measure interruptions. n Our advisor has helped us to create a preliminary taxonomy to measure the numbers, types and causes of interruptions in the VU ED.

Survey of ED Staff n Our project will conclude with a survey of the ED staff. n This will be used to validate our findings on which activities contribute to system errors. n Since we are not able to observe for long time intervals, the survey will inform us of what we miss.

Collaborations n Our project advisor has completed two observations. n We are collaborating with Scott Levin, a first year graduate student who plans to base his doctoral thesis on a related topic. n Scott is also currently doing observations, and he hopes to publish his work this summer.

Thank you! Dr. Dan France Dr. Robin Hemphill Dr. Paul King Scott Levin Scott Levin