Emergency department (ED) doctors spend less time directly caring for patients, and more time on indirect care; and frequent interruptions while working are a contributing factor to medical errors, according to a recent study by researchers at the University of Indiana.
The study was published in the Annals of Emergency Medicine (2011; published online ahead of print). The researchers looked at ED physicians in two settings – academic emergency rooms, and community hospital emergency rooms.
Regardless of the setting, researchers determined that the majority of ED physicians’ activities are spent on indirect patient care, such as charting, reviewing medical records, interacting with consultants, and interpreting tests. Advances in electronic record keeping and point of care testing have not increased the amount of time a physician can spend with a patient, or decreased physicians’ indirect care activities.
More alarming, however, is the frequency of interruptions in the ED. The nature of ED work is harried and demanding. Physicians are treating multiple patients at once. In community hospitals, ED physicians are caring for a median of six patients but as many as 12. In academic hospital settings, ED physicians are caring for a median of seven patients but may be trying to treat as many as 16 at the same time.
Physicians are frequently interrupted in both settings – as many as 32 times per two hour period for academic settings and up to 19 per two hour period for community hospitals. Researchers found the numbers of interruptions a cause for concern as distractions are often linked to medical errors.
Lead study author Carey D. Chisholm, MD, an ED physician at Indiana University School of Medicine and Methodist Hospital in Indianapolis, noted that some reports have suggested that when physicians are interrupted, they fail to return to the interrupted task one in five times. Dr. Chisholm also noted that existing evidence supports the negative effect of interruptions on performance, and that interruptions also increase the perception of stress.