Emergency rooms are one of the most unpredictable settings a health care worker can be in, and often serve as a patient’s front-line of care. At any moment someone could walk through the door with a life threatening emergency requiring rapid decision-making and the full, alert attention of staff. Nurses in emergency departments work with patients arriving after acute traumas and injuries, motor vehicle accidents, suicide attempts, cases of abuse and neglect,  sexual assault as well as a whole slew of other varying conditions. It is critical for these nurses to be able to maintain their focus through minimizing unnecessary interruptions. The most common sources of interruption to ER nurses and the implications of such interruptions will be highlighted in today’s post.

 

What Constitutes an Interruption?

An interruption occurs when a nurse’s primary task is temporarily postponed so that a second activity can receive attention. Interruptions can come about in a few different forms, such as:1

  • Intrusions—an unexpected encounter with someone interrupts the main task
  • Distractions—an external stimulus or additional activity causes the person to lose concentration of the primary task
  • Breaks—a planned or unplanned pause while conducting the primary task
  • Disagreements—a lack of consensus or approval for the primary task being performed

Regardless of the method by which an interruption occurs, these incidences have been shown to be the chief overall contributor of failures related to the working environment of hospitals.

 

Most Common Sources of Interruptions 

A research study conducted in an emergency department at the Mayo Clinic in Rochester, Minnesota found that while delivering care to patients the 5 most noted sources of interruption to nurses included:2,3

  • Phone calls
  • Colleagues
  • Residents
  • Doctors
  • Relatives

From this information we can discern that although communication between the various health team members can be an essential component in delivering care to patients, these individuals can also serve as a strong source distraction. Likewise, the questions and concerns of a patient’s relatives need to be addressed without allowing these discussions to evolve into a drain of time resources.

 

The Timing of Interruptions

In the same study mention above, interruptions in the emergency department occurred most frequently during two important procedures: electronic health record (EHR) documentation and direct patient care.2,3The implementation of electronic health record systems has become widespread in recent years, but the effect that these electronic systems have on documentation time has consistently been inconclusive.4Regardless, interruptions while documenting can lead to omissions or mistakes in the records as well as prolonged time spent away from providing direct patient care.5

 

Longer Emergency Room Wait-Times

The annual volume of emergency department visits has been on the rise, which has lead to higher incidences of overcrowding and longer wait times. Depending on the volume of patients an emergency department has to accommodate, average wait times range from 24 minutes to nearly 50 minutes.6In serious cases this wait time can have severe, avoidable consequences on a patient’s health outcomes.7Distractions to nurses cause a decrease in total productivity and efficiency that can ultimately add up and largely contribute to these longer waiting periods.

 

Increased Nurse Workload

The study performed at the Mayo Clinic ER found that nurses’ mental workload was 2x higher during patient care, and almost 5x higher during EHR charting when interruptions occurred at a higher frequency.2As burnout continues to be an issue within the nursing profession reducing the perceived mental workload of nurses is a high priority. This study suggests that reducing interruptions could help to lessen the stress being endured by ER nurses.

 

Educating the Workforce

Some interruptions, such as communication between the members of the healthcare delivery team, are necessary for delivering quality care to patients. Eliminating all of these interruptions would thus be a futile and damaging endeavor. Instead, hospital organizations somehow need to target the unnecessary and avoidable distractions nurses are dealing with. The research conducted at the Mayo Clinic demonstrates a need for E.R. nurses to receive training on how to deal with interruptions. Educating the workforce on how small interruptions can add up and negatively impact workload and productivity is the first step towards achieving this goal.

 

References:

  1. Monteiro C, Avelar AF, Pedreira Mda L. Interruptions of nurses’ activities and patient safety: an integrative literature review. Rev Lat Am Enfermagem. 2015;23(1):169–179. doi:10.1590/0104-1169.0251.2539

2.Kim JH, Parameshwara N, Guo W, Pasupathy KS. The Impact of Interrupting Nurses on Mental Workload in Emergency Departments. Int J Hum Comput Interact. 2019;35(3):206-217. doi:10.1080/10447318.2018.1447421

  1. Sossamon J. These interruptions slow down E.R. nurses. Futurity.org. https://www.futurity.org/emergency-room-nurses-efficiency-1735072/. Published April 19, 2018. Accessed July 8, 2019.
  2. Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy. 2018;122(8):827-836. doi:10.1016/j.healthpol.2018.05.014