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): , and
2Hollingsworth, Jason C., et al. “How do Physicians and Nurses Spend Their Time in the
Emergency Department?” Annals of Emergency Medicine (1998):

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