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Santos CN, Pedrosa BF, Martins M, Gouveia F, Franco F, Vardasca MJ, Pedro B, Nogueira JD. Interruptions during general practice consultations: negative impact on physicians, and patients' indifference. Fam Pract 2024; 41:494-500. [PMID: 36409278 DOI: 10.1093/fampra/cmac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Interruptions can impact consultation duration, doctors and patients' satisfaction, and quality of care provided. Although most of them seem to have a negative impact, affecting doctor-patient relationship and interfering with clinical reasoning, which increases the risk of error, there is still no evidence on their global impact on consultations. OBJECTIVES To evaluate the number and duration of interruptions during general practice consultations. To compare physicians and patients' perceptions of their urgency and impact, as well as the overall satisfaction with the consultation. METHODS Cross-sectional study of a representative sample of annual face-to-face general practice consultations at a Health Centre. Between January and March 2022, anonymous questionnaires were given to physicians and patients after consultation. We performed a descriptive and inferential statistical analysis. RESULTS A total of 403 consultations were included. Physicians reported more interruptions than patients (108 vs. 87, P < 0.001). From patients' perspective those interruptions were more urgent (34.5%) compared with physicians' perspective (20.6%; P = 0.029). Patients undervalued their impact on consultations (7.1% of interruptions with a negative impact among patients vs. 24.7% among doctors; P < 0.001). Interruptions did not interfere with patients' satisfaction with consultation (P = 0.135) but were associated with lower physicians' satisfaction with consultation (P = 0.003). CONCLUSION Physicians are more critical regarding consultations interruptions, being more aware of their incidence and reporting more often a negative impact, which translates into lower satisfaction with interrupted consultations. Patients devalue the occurrence of interruptions, showing no concern about their impact on security or privacy, and their satisfaction is not affected by them.
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Affiliation(s)
| | | | | | - Fábio Gouveia
- USF Ramada, ACeS Loures-Odivelas-ARSLVT, Lisboa, Portugal
| | - Fátima Franco
- USF Ramada, ACeS Loures-Odivelas-ARSLVT, Lisboa, Portugal
| | | | - Bernardo Pedro
- USF Ramada, ACeS Loures-Odivelas-ARSLVT, Lisboa, Portugal
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Danesh V, Sasangohar F, Kallberg AS, Kean EB, Brixey JJ, Johnson KD. Systematic review of interruptions in the emergency department work environment. Int Emerg Nurs 2022; 63:101175. [PMID: 35843150 DOI: 10.1016/j.ienj.2022.101175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to describe the operationalization of interruptions measurement and to synthesize the evidence on the causes and consequences of interruptions in the emergency department (ED) work environment. METHODS This systematic review of studies explores the causes and consequences of interruptions in the ED. Of 2836 abstract/titles screened, 137 full-text articles were reviewed, and 44 articles met inclusion criteria of measuring ED interruptions. RESULTS All articles reported primary data collection, and most were cohort studies (n = 30, 68%). Conceptual or operational definitions of interruptions were included in 27 articles. Direct observation was the most common approach. In half of the studies, quantitative measures of interruptions in the ED were descriptive only, without measurements of interruptions' consequences. Twenty-two studies evaluated consequences, including workload, delays, satisfaction, and errors. Overall, relationships between ED interruptions and their causes and consequences are primarily derived from direct observation within large academic hospitals using heterogeneous definitions. Collective strengths of interruptions research in the ED include structured methods of naturalistic observation and definitions of interruptions derived from concept analysis. Limitations are conflicting and complex evaluations of consequences attributed to interruptions, including the predominance of descriptive reports characterizing interruptions without direct measurements of consequences. CONCLUSIONS The use of standardized definitions and measurements in interruptions research could contribute to measuring the impact and influence of interruptions on clinicians' productivity and efficiency as well as patients' outcomes, and thus provide a basis for intervention research.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Health, 3500 Gaston Ave, Dallas, TX 75246, United States.
| | - Farzan Sasangohar
- Applied Cognitive Ergonomics Lab Texas, A&M University, Houston, TX, United States; Industrial and Systems Engineering, Texas A&M University, 4079 Emerging Technologies Building, 3131 TAMU, College Station, TX 77843, United States.
| | - Ann-Sofie Kallberg
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Emergency Medicine, Falun Hospital, Dalarna University, SE-79188, Sweden.
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, 231 Albert Sabin Way, Cincinnati, OH 45267, United States.
| | - Juliana J Brixey
- Biomedical Informatics and Nursing, The University of Texas Health Science Center, 6901 Bertner Ave, Rm 629, Houston, TX 77030, United States.
| | - Kimberly D Johnson
- University of Cincinnati, College of Nursing, 234 Proctor Hall 3110 Vine St., Cincinnati, OH 45221, United States.
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Nurses’ and patients’ perceptions on interruptions on admission processes at an acute public hospital using cross-sectional survey. Collegian 2022. [DOI: 10.1016/j.colegn.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Weir BS, Vordtriede C, Lee JE, Metter EJ, Talbot LA. An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative. Mil Med 2021; 188:usab526. [PMID: 34950952 DOI: 10.1093/milmed/usab526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. MATERIALS AND METHODS The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. RESULTS With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). CONCLUSIONS The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.
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Affiliation(s)
- Brett S Weir
- Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Caitrin Vordtriede
- Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | | | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Johnson KD, Lindsell CJ, Froehle C, Gillespie GL. Interruption of initial patient assessment in the emergency department and its effect on patient perception of care quality. Int J Qual Health Care 2021; 33:6423704. [PMID: 34750630 DOI: 10.1093/intqhc/mzab146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Triage is a critical first step in appropriately caring for patients in the emergency department (ED). Patients' assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction. OBJECTIVE The purpose of this study was to determine how the frequency and duration of interruptions during triage are associated with errors, patient satisfaction and patient's perception of the care they received. METHODS Prospective, observational, cohort study conducted in the ED of a Level 1 trauma center. Interruptions were measured using time-and-motion observations of triage interviews performed by nurses and physicians. Patients were surveyed immediately after triage interviews were complete. RESULTS Surveys were completed for 178 observations. In total, 62.9% of the observations were interrupted between 1 and 5 times. While interruptions did not significantly influence patient satisfaction directly, interruptions positively influenced triage duration, which was negatively associated with patient satisfaction. Increased errors were associated with increasing frequency of triage interruptions. Triage interruptions were not associated with either patient satisfaction or perceived caregiver competence. Overall, the majority (76.6%) of patients were satisfied with their care; patient satisfaction was associated with the perceived competency of caregivers but was not associated with errors. CONCLUSION Interruptions are associated with increased errors and delays in patient care. Although increased triage duration adversely affected patient satisfaction, patients' perceptions were not influenced by interruptions. While patient satisfaction is essential, a lack of association between patient satisfaction and errors suggests that using patient satisfaction as a measure of care quality may omit important safety information.
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Affiliation(s)
- Kimberly D Johnson
- College of Nursing, University of Cincinnati, (UC) 3110 Vine St Cincinnati, Cincinnati, OH 45221, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, (vanderbilt) 2201 West End Ave, Nashville, TN 37235, USA
| | - Craig Froehle
- Department Head-Operations, Business Analytics & Information Systems, UC Lindner College of Business, Cincinnati, OH 45221, USA.,Department of Emergency Medicine, UC College of Medicine, Cincinnati, OH 45221, USA
| | - Gordon Lee Gillespie
- Graduate Occupational Health Nursing Program, University of Cincinnati College of Nursing, Cincinnati, OH 45221-0038, USA
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Lee T, Rosario H, Cifuentes E, Cui J, Lin EC, Miller VA, Lin HC. Review of interruptions in a pediatric subspecialty outpatient clinic. PLoS One 2021; 16:e0254528. [PMID: 34324552 PMCID: PMC8320932 DOI: 10.1371/journal.pone.0254528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe interruptions in the pediatric ambulatory setting and to assess their impact on perceived physician communication, patient satisfaction and recall of provided physician instructions. METHODS An observational study was performed at the Children's Hospital of Philadelphia, Pediatric Gastroenterology clinic. Participation consisted of video recording the clinic visit and the caregiver completed post-visit surveys on communication and satisfaction. Video recordings were coded for interruptions, which were divided into 3 main categories: Visit Associated, Pediatric Associated, and Unanticipated. An interruption rate was calculated and correlated with the following outcome variables to assess the impact of interruptions: caregiver satisfaction, caregiver perception on the quality of physician communication, and caregiver instruction recall. RESULTS There were 675 interruptions noted in the 81 clinic visits, with an average of 7.96 (σ = 7.68) interruptions per visit. Six visits had no interruptions. The Patient was the most frequent interrupter. Significantly higher interruption rates occurred in clinic visits with younger patients (<7 years old) with most of the interruptions being Pediatric Associated interruptions. There was minimal correlation between the clinic visit interruption rate and caregiver satisfaction with the communication, caregiver perception of quality of communication, or caregiver instruction recall rate. CONCLUSION The effect of interruptions on the pediatric visit remains unclear. Interruptions may be part of the communication process to ensure alignment of the patient's agenda. Additional studies are needed to help determine the impact of interruptions and guide medical education on patient communication.
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Affiliation(s)
- Tyler Lee
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Hinette Rosario
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth Cifuentes
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Jiawei Cui
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Emery C. Lin
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Victoria A. Miller
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Henry C. Lin
- Division of Pediatric Gastroenterology, Doernbecher Children’s Hospital, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
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Kwon YE, Kim M, Choi S. Degree of interruptions experienced by emergency department nurses and interruption related factors. Int Emerg Nurs 2021; 58:101036. [PMID: 34332454 DOI: 10.1016/j.ienj.2021.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
AIMS This study examined the degree of interruptions experienced by emergency department nurses and related factors. METHODS This study is a descriptive survey using standardized observation tools. A total of 23 nurses working in an emergency department participated in this study. Using a stopwatch over 120 h, the degree of interruptions was investigated by measuring start and end times of tasks and interruptions. Factors related to interruptions were classified as communication, telephone calls, medical device alarms, changes in patient condition, and other factors. RESULTS The frequency of interruptions in the emergency department was 6.4 times per hour, and its percentage was 9.1%. The time required for actual nursing tasks of "counseling and education," "safety," and "patient nursing management and information management" were increased significantly due to interruptions. A primary factor in interruptions was communication with patients, families, and nurses. The longest duration and the highest frequency of interruptions occurred during medication tasks. CONCLUSIONS Communication with patients, families, and nurses was the highest factor related to interruptions. Nurses may cause interruptions and be subjected to interruptions simultaneously. Therefore, nurses in the emergency department should work with caution not to cause interruptions.
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Affiliation(s)
- Yong Eun Kwon
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.
| | - Miyoung Kim
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.
| | - Sujin Choi
- College of Nursing, Woosuk University, Jeonju, Republic of Korea.
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