• J Emerg Med · Apr 2021

    Quantifying Emergency Physician Interruptions due to Electrocardiogram Review.

    • IoannidesKimon L HKLHDepartment of Emergency Medicine, University of California Los Angeles, Los Angeles, California., Daniel James Brownstein, Andrew J Henreid, Sam S Torbati, and Carl T Berdahl.
    • Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California.
    • J Emerg Med. 2021 Apr 1; 60 (4): 444-450.

    BackgroundInterruptions are recognized as potentially harmful to safety and efficiency, and are especially prevalent in the emergency department (ED) setting. Policies urging immediate review of all electrocardiograms (ECGs) may lead to numerous and frequent interruptions.ObjectiveWe assessed the role of ECG review as a source of ED interruptions to characterize a potential target for interventions.MethodsWe analyzed emergency physician time use during the course of a clinical shift using a time-and-motion design. A research assistant observed a convenience sample of shifts, observing and logging transitions between different tasks using an electronic device. Instances of ECG review were tallied, with start and ending times of ECG review recorded to the nearest second. An ECG review was considered an interruption if the immediate prior and subsequent tasks were the same.ResultsTwenty shifts were observed for a total of 149 h. There were 211 ECG reviews, (mean rate 1.4 per hour), with more frequent review among physicians staffing a zone with higher-acuity patients (2.8 per hour), where clustering of multiple ECG reviews in succession was more common. Seventy-five percent of ECG reviews required < 30 s. Of all 211 ECG reviews, 102 (48%) were an interruption. The tasks most frequently interrupted were electronic medical record system use (68 of 102, 67%) and communicating with ED staff in person (18 of 102, 18%).ConclusionsReview of ECGs was a substantial driver of interruptions for emergency physicians. Interventions to integrate ECG review more naturally into physician workflow may improve patient safety by reducing these interruptions.Copyright © 2020 Elsevier Inc. All rights reserved.

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