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Please Don't Interrupt the Doctor: Lives Could Be At Risk

June 8, 2010
by Mark Hagland
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I recently came across a fascinating article online, from a publication called Quality and Safety in Health Care, which is published by the group that publishes the British Medical Journal. The title of the article? “The impact of interruptions on task completion.” Sounds dry, perhaps—but it isn’t, when you think even for a moment about the implications of what was learned.

Here’s what happened: a group of Australian medical researchers conducted an observational time-and-motion study in the emergency department of a 400-bed teaching hospital in Australia. They observed 40 physicians over a period of more than 200 hours, and found that doctors were interrupted 6.6 times an hour; that 11 percent of all tasks were interrupted; and that 3.3 percent of tasks were interrupted more than once. They also found that physicians multitasked 12.8 percent of the time. Their conclusion? “It appears that in busy, interrupt-driven clinical environments, clinicians reduce the time they spend on clinical tasks if they experience interruptions, and may delay or fail to return to a significant portion of interrupted tasks. Task shortening may occur because interrupted tasks are truncated to ‘catch up’ for lost time, which may have significant implications for patient safety.” I’ll say!!!

Consider for just a moment the typical types of “tasks” that physicians perform in hospital emergency departments on a moment-to-moment basis. They are diagnosing symptoms of severe pain and infection, attending to gunshot wounds, ordering life-saving meds, interpreting complex diagnostic images, and providing patients with absolutely critical information and instructions, all on continuous deadlines, among countless other crucial tasks. So to think that doctors are interrupted 6.6 times an hour, and that 11 percent of all tasks are interrupted—that’s doubtless rather serious (though not in any way surprising).

If anything, for me, learning of the results of this time-and-motion study reinforce my passion about what you, are readers are working on day in and day out—implementing the absolutely vital clinical information systems that build greater patient safety into the patient care delivery process. Given the confluence of numerous rather jarring factors—the rapid advancement of clinical care in every medical subspecialty; the ever-accelerating brain-scrambler of new, sound-alike prescription drugs into the care arena; the scorching pace of care delivery and clinician workflow in every area of the hospital, but most certainly in today’s overcrowded ED; and numerous other factors—implementing exceptionally useful, valuable clinical information systems has become more important than ever, to help offset the elements, such as interruptions of physician concentration, that will always be a part of care delivery.

And it is precisely because care delivery tasks are constantly being interrupted, that physicians—and all clinicians, most certainly including nurses—need the best possible IT support they can get. If it were your grandmother’s care being interrupted, wouldn’t you want that support to be there for her doctor?

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Comments

Mark,
That's a great piece. Having worked in a hospital I fully understand and agree with the findings.
Now consider the goal of meaningful use.
In order to have the user 'meaningfully use' the system, the system will have to adapt to the clinicians work flow. If the work flow is frought with interuptions then the systems we deploy must be able to be interupted in mid-stream to respond to the clinicians change in direction or emphasis.
Unfortunately there are very few systems on the market today that can accomodate that level of interuption and redirection. That is why I believe getting to meaningful use is going to be far more of a challenge than most people think.

Unless of course if the feds water down the definition of MU to be simple things like generating a report or responding to an alert.

While I am not a physician, nurse, or other medical professional, I hire nurses, social workers, and other support staff in a non-traditional intensive medical case management program for children, youth, and women with HIV and their families. Probably the only real question I'm interested in pursuing with vigor is, "If the patient is your sister/mother/brother or significant other, what would you want them to receive from our multi-disciplinary team?" I then look for the answer, "everything that's available," because that's what I would say. I would also expect my staff to serve our clients as if they were family. So I'm happy to see that I'm not the only one who expresses that position. Thank you!!

Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...