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Enhancing Efficiency in Emergency Care: Addressing Physician Interruptions at Vanderbilt ED

This study examines types and frequencies of physician interruptions in Vanderbilt University Emergency Department to improve patient care, communication, and reduce complaints. Recommendations include separate charting room, minimizing distractions, and computerized charting system. Results reveal interruption tendencies during tasks and their types. Observations and literature review guide the methodology. Key terms defined, highlighting impacts on patient care.

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Enhancing Efficiency in Emergency Care: Addressing Physician Interruptions at Vanderbilt ED

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  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): 415-418., and 2Hollingsworth, Jason C., et al. “How do Physicians and Nurses Spend Their Time in the Emergency Department?” Annals of Emergency Medicine 31.1 (1998): 87-91.

  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

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