Emergency department workplace interruptions: Are emergency physicians "interrupt-driven" and "multitasking"?

Objective: Although interruptions have been shown in aviation and other wor k settings to result in error with serious and sometimes fatal consequences , little is known about interruptions in the emergency department (ED). The authors conducted an observational, time-motion task-analysis study to det ermine the number and types of interruptions in the ED. Methods: Emergency physicians were observed in three EDs located in an urban teaching hospital , a suburban private teaching hospital, and a rural community hospital. A s ingle investigator followed emergency staff physicians for 180-minute perio ds and recorded tasks, interruptions, and breaks-in-task. An "interruption" was defined as any event that briefly required the attention of the subjec t but did not result in switching to a new task. A "break-in-task" was defi ned as an event that required the attention of the physician for more than 10 seconds and subsequently resulted in changing tasks. Results: The mean ( +/-SD) total number of patients seen at all three sites during the 180-minu te study period was 12.1 +/- 3.7 patients (range 5-20). Physicians performe d a mean of 67.6 +/- 15.7 tasks per study period. The mean number of interr uptions per 180-minute study period was 30.9 +/- 9.7 and the mean number of breaks-in-task was 20.7 +/- 6.3. Both the number of interruptions (r = 0.6 3; p < 0.001) and the number of breaks-in-task (r = 0.56; p < 0.001) per ob servation period were positively correlated with the average number of pati ents simultaneously managed. Conclusions: Emergency physicians are "interru pt-driven." Emergency physicians are frequently interrupted and many interr uptions result in breaks-in-task.