Original ContributionsWork interrupted: A comparison of workplace interruptions in emergency departments and primary care offices*,**,*,**
Introduction
Sociologist Lewis Mumford lamented, “Today, the degradation of the inner life is symbolized by the fact that the only place sacred from interruption is the private toilet.”1 And this was written in 1938, before the advent of beepers and cellular telephones. Attentional dynamics, those factors that govern the control of attention and the management of mental workload, are some of the important cognitive factors that affect the performance of practitioners in a complex setting, such as medicine.2 Such factors are critical in reducing error in health care because the practitioner whose attention is constantly shifting from one item to another may not be able to formulate a complete and coherent picture of the state of the system.2
We previously studied how emergency physicians and emergency nurses spend their time in emergency departments, finding that almost half their time was spent on indirect patient care activities.3 We then conducted an observational study in the same EDs, as well as in a community and rural hospital ED, that examined the same number and types of interruptions encountered, as well as the number of patients concurrently under the care of emergency physicians and the number of tasks they performed.4 Because the emergency physicians were interrupted an average of 10.3 times per hour, we concluded that emergency physicians were both “interrupt driven” and “multitasking,” terms borrowed from the computer sciences lexicon.
Interrupt-driven computer programs receive interrupt signals that cause them to temporarily suspend their current activity. Unlike computers that mindlessly pick up where they left off, human beings often find themselves distracted and unable to concentrate when they return to tasks after interruptions.5 Ozawa noted, “Critical thinking and analysis get lost in an interrupt-driven workplace.”5 The term multitasking refers to managing multiple tasks simultaneously.
The number of workplace interruptions may be an important ergonomic factor contributing to inefficiency, increased error, stress, and job dissatisfaction in both health care and non–health care workplaces. Little research, however, has been conducted to compare interruption rates among different medical practices where workloads and other ergonomic and practice characteristics may differ. For example, because patient visits to the ED are unscheduled, there are irregular peaks and troughs in the number of patients and severity levels of illness and injury. Emergency physicians must often shift their attention to prioritize the unannounced arrival of critically ill or injured patients. Because we are unaware of any study that has compared the ED work environment with the primary care work environment, we conducted an observational study to determine the number of interruptions and simultaneous tasks in both workplaces. Our null hypothesis stated that there are no differences in the number of interruptions and simultaneous tasks between emergency physicians and primary care physicians (PCPs).
Section snippets
Materials and methods
Twenty-two emergency physicians in 5 nonteaching community hospitals and 22 PCPs (6 pediatric, 6 internal medicine, 6 family medicine, and 4 internal medicine-pediatric physicians) were observed in their work environments from June 12 through August 1, 1998. None of the study sites were postgraduate medical training facilities. The primary care study sites were located in the Indianapolis metropolitan area and included both private and managed care practices. The EDs were located in 5 smaller
Results
Demographic data and main results are reported in Table 3.There were more women in the PCP group (40.9%) compared with the emergency physician group (14.3%), which approached statistical significance (P =.052, χ2 test). Other demographic variables did not approach statistical significance between the 2 groups, indicating that they were generally comparable.
Emergency physicians were interrupted nearly 3 times more than their primary care counterparts. Emergency physicians experienced
Discussion
In this observational study, both PCPs and emergency physicians were frequently interrupted. The higher number of interruptions for the emergency physician likely reflects the differences in the work environments, as well as the limits of the study design. Emergency physicians are hospital-based shift workers caring for unscheduled patients in a work environment typified by peaks and troughs of patient influx. Their work shifts (typically 8-12 hours in length) provide coverage 24 hours a day, 7
Acknowledgements
Author contributions: CDC and WHC conceived the study. CDC, AMD, DRN, and WHC designed the study, analyzed and interpreted the data, drafted the manuscript, and contributed substantially to its revision. DRN served as the project statistician. As described in greater detail in the Methods section, AMD collected the study data. CDC takes responsibility for the paper as a whole.
We thank the 44 physicians who graciously allowed us to evaluate their practice environments.
References (18)
- et al.
How do physicians and nurses spend their time in the emergency department?
Ann Emerg Med
(1998) House officer education and organizational obstacles to quality improvement
Jt Comm J Qual Improv
(1996)The Culture of Cities
(1938)- et al.
Operating at the sharp end: the complexity of human error
- et al.
Emergency department work place interruptions: are emergency physicians “interrupt-driven” and “multitasking”?
Acad Emerg Med
(2000) Workplace: Memo 4/8/97, FYI: Messages inundate offices
Wall Street Journal.
(April 8, 1997)Was there a Hawthorne effect?
Am J Sociol.
(1992)Coping with competing demands: interruption and the type A pattern
J Appl Psychol
(1988)- et al.
Interruptions during general practice consultations—the patients’ view
Fam Pract
(1996)
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Ms. Dornfeld is currently a medical student at Stritch School of Medicine of Loyola University, Chicago, IL, and Mr. Nelson is currently with the Department of Biostatistics, Cleveland Clinic, Cleveland, OH.
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Author contributions are provided at the end of this article.
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Supported by a Methodist Hospital Student Summer Research Program grant (Ms. Dornfeld).
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Reprints not available from the authors.