Residents, Interrupted: A Blinded, Prospective Observational Study of Emergency Medicine Resident Workflow

Abstract

Background: Emergency Medicine (EM) physicians routinely contend with frequent interruptions to their workflow, which can introduce errors and decrease efficiency. In Academic EM, residents serve as the main point of contact for patient care and are similarly susceptible to significant interruption burden. Our objective was to evaluate the number and characteristics of interruptions residents experience during an EM shift, including interruptions based on gender. Methods: This was a double-blinded time-motion observation study that included 70 resident physicians (PGY1-PGY5). Data were collected by two trained observers who were blinded to the gender hypothesis. Each resident was observed for a 4-h block. Observations took place during all hours of ED operation, including overnight, in both high and low acuity settings across three Level 1 Trauma centers including an academic, a county, and a pediatric Emergency Department (ED). Results: Observations totaled 280 h. There was no significant difference in the number of interruptions based on gender. At both non-pediatric centers, there were significantly more interruptions in the high acuity area than in the low acuity area (6.2 and 7.8 more interruptions, p = 0.043, 0.0043, respectively). Many interruptions (37%) occurred during order entry, a critical patient safety action. Charting was frequently interrupted (41.5%), which can negatively impact wellness. Residents did not return to their initial task 17% of the time and nearly 93% did not advocate stopping the interruption. When compared to nursing staff, ancillary staff, and co-residents, attending physicians most frequently caused interruptions (p < 0.0001). Conclusions: EM residents in this study experienced frequent interruptions. Although bias has been documented throughout clinical education, we did not detect differences based on gender. Future education should address the impact of interruptions on patient safety and empower residents to improve task-switching ability. Increased awareness of the attending role in perpetuating interruptions may improve safety, on-shift education, and resident workflow.