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Knight E, Sanderson P, Neal A, Ballard T. Interruptions in healthcare: Modeling dynamic processes and effects at a team level. Appl Ergon 2023; 112:104051. [PMID: 37269585 DOI: 10.1016/j.apergo.2023.104051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
Interruptions are associated with increases in medical errors amongst healthcare professionals, yet interventions to reduce interruptions have not been widely successful. While interruptions can be problematic for the interruptee, they may be necessary for the interrupter to maintain patient safety. To understand the emergent effects of interruptions within a dynamic environment, we develop a computational model that describes how nurses make decisions about interruptions and the effects those decisions have at a team level. Simulations reveal the dynamic interplay between urgency, task importance, the cost of being interrupted and team efficiency, depending on the consequences of clinical or procedural error, and shed light on the ways that the risks from interruptions can be better managed.
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Affiliation(s)
- Emma Knight
- School of Psychology, The University of Queensland, Brisbane, Australia.
| | | | - Andrew Neal
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Timothy Ballard
- School of Psychology, The University of Queensland, Brisbane, Australia
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Owen S, Menzies J, Pontefract S. Educational interventions to reduce nurse medication interruptions: A scoping review. Nurse Educ Today 2023; 121:105665. [PMID: 36527755 DOI: 10.1016/j.nedt.2022.105665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Preventable harm from medicines is a global problem creating huge economic and social burden. Interruptions occur frequently in clinical environments causing medication episodes to take longer and having a cognitive cost on the nurse. AIM The aim of this scoping review is to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety. METHODS Six databases were searched for the scoping review (PubMed, Embase, Cochrane Library, CINAHL, Pishin and Medline) along with reference lists and grey literature searches. Articles were included if they were written in English, published between 2010 and 2020 and employed an education intervention (including bundled interventions). Databases were searched using keywords and Boolean operators. RESULTS Eight studies met the inclusion criteria. Seven of these studies were conducted in hospital (adults n = 6, paediatric n = 1) and one study in a university with undergraduate nurses. Four studies used a combined intervention and four exclusively employed an education intervention. Five studies found a significant decrease in the number of interruptions post intervention, but one of the studies that exclusively employed an education intervention found no significant difference. Changes in the nurses' behaviour post intervention were also cited in two studies. IMPLICATIONS FOR FUTURE RESEARCH There was a lack of exclusive education interventions, making it difficult to determine the effectiveness of education at reducing medication interruptions. This review highlights the necessity of some interruptions when performing tasks, for example, to make a nurse aware of a deteriorating patient. However, as the majority of studies used the number of interruptions to determine the effectiveness of the intervention, there is uncertainty as to whether this is the right outcome measure to use. In the future, a focus on outcome measures reflecting change in nurse behaviour may be more effective in determining the strength of an educational intervention.
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Affiliation(s)
- Samantha Owen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK.
| | | | - Sarah Pontefract
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Abdelhadi N, Drach‐Zahavy A, Srulovici E. Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability. Nurs Open 2022; 9:309-319. [PMID: 34612602 PMCID: PMC8685781 DOI: 10.1002/nop2.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN A qualitative descriptive design. METHODS Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.
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Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Anat Drach‐Zahavy
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Einav Srulovici
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
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Khalil V, Bates A. Assessing the impact of a mixed intervention model on the reduction of medication administration errors in an Australian hospital. Ir J Med Sci 2021. [PMID: 34859334 DOI: 10.1007/s11845-021-02872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Medication errors remain one of the most common types of incidents reported in Australian hospitals. Studies have reported that for every 10 medication administrations, a medication administration error is likely to occur and reach the patient, potentially contributing to a preventable patient harm. OBJECTIVE To assess the impact of a mixed intervention model on medication administration errors in an Australian hospital. METHODS Two types of intervention model (human and system orientated) were implemented through collaboration with key stakeholders (nurses, educators, and policy makers) to reduce medication administration errors across this 650-bed multisite Australian hospital from August 2018 to June 2019. To assess the impact of the mixed intervention model, the total number of reported medication errors and the number of medication administration errors were retrieved from the hospital electronic medication management system for 12 months before (from June 2017 to July 2018) and after (from July 2019 to June 2020) implementation of all interventions. RESULTS Implementation of a mixed intervention model through collaboration with stakeholders resulted in significant reduction in the number of medication administration errors, and those with harm (from 68 to 55%, P < 0.0001 and from 12 to 8%, P = 0.0001 respectively). Additionally, the severity of medication administration errors was also reduced (HR 0.562, 95% CI (0.298-1.062)) in the post-intervention phase. CONCLUSION Introducing a mixed intervention model reduces medication administration errors across health settings and has the potential to drive excellence in healthcare.
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Freitas WCJD, Menezes AC, Mata LRFD, Lira ALBDC, Januário LH, Ribeiro HCTC. Interruption in the work of nursing professionals: conceptual analysis. Rev Bras Enferm 2021; 75:e20201392. [PMID: 34705993 DOI: 10.1590/0034-7167-2020-1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/18/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the concept of "interruption in the work of nursing professionals". METHODS conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies. RESULTS the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus. FINAL CONSIDERATIONS theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.
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Berdot S, Vilfaillot A, Bezie Y, Perrin G, Berge M, Corny J, Thi TTP, Depoisson M, Guihaire C, Valin N, Decelle C, Karras A, Durieux P, Lê LMM, Sabatier B. Effectiveness of a 'do not interrupt' vest intervention to reduce medication errors during medication administration: a multicenter cluster randomized controlled trial. BMC Nurs 2021; 20:153. [PMID: 34429095 PMCID: PMC8383384 DOI: 10.1186/s12912-021-00671-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background The use of a ‘do not interrupt’ vest during medication administration rounds is recommended but there have been no controlled randomized studies to evaluate its impact on reducing administration errors. We aimed to evaluate the impact of wearing such a vest on reducing such errors. The secondary objectives were to evaluate the types and potential clinical impact of errors, the association between errors and several risk factors (such as interruptions), and nurses’ experiences. Methods This was a multicenter, cluster, controlled, randomized study (March–July 2017) in 29 adult units (4 hospitals). Data were collected by direct observation by trained observers. All nurses from selected units were informed. A ‘Do not interrupt’ vest was implemented in all units of the experimental group. A poster was placed at the entrance of these units to inform patients and relatives. The main outcome was the administration error rate (number of Opportunities for Error (OE), calculated as one or more errors divided by the Total Opportunities for Error (TOE) and multiplied by 100). Results We enrolled 178 nurses and 1346 patients during 383 medication rounds in 14 units in the experimental group and 15 units in the control group. During the intervention period, the administration error rates were 7.09% (188 OE with at least one error/2653 TOE) for the experimental group and 6.23% (210 OE with at least one error/3373 TOE) for the control group (p = 0.192). Identified risk factors (patient age, nurses’ experience, nurses’ workload, unit exposition, and interruption) were not associated with the error rate. The main error type observed for both groups was wrong dosage-form. Most errors had no clinical impact for the patient and the interruption rates were 15.04% for the experimental group and 20.75% for the control group. Conclusions The intervention vest had no impact on medication administration error or interruption rates. Further studies need to be performed taking into consideration the limitations of our study and other risk factors associated with other interventions, such as nurse’s training and/or a barcode system. Trial registration The PERMIS study protocol (V2–1, 11/04/2017) was approved by institutional review boards and ethics committees (CPP Ile de France number 2016-A00211–50, CNIL 21/03/2017, CCTIRS 11/04/2016). It is registered at ClinicalTrials.gov (registration number: NCT03062852, date of first registration: 23/02/2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00671-7.
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Affiliation(s)
- Sarah Berdot
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France. .,INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.
| | - Aurélie Vilfaillot
- Clinical Research Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Yvonnick Bezie
- Pharmacy Department, Paris Saint Joseph Hôpital, Paris, France
| | - Germain Perrin
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Marion Berge
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Jennifer Corny
- Pharmacy Department, Paris Saint Joseph Hôpital, Paris, France
| | | | - Mathieu Depoisson
- Pharmacy Department, Hôpital Vaugirard and Hôpital Corentin Celton, APHP, Paris, France
| | - Claudine Guihaire
- DSAP, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Nathalie Valin
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Claudine Decelle
- Department of Nephrology, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,Paris Descartes University, Paris, France.,INSERM, PARCC, Paris, France
| | - Pierre Durieux
- INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Laetitia Minh Maï Lê
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,Lip(Sys)2, EA7357, UFR Pharmacie, U-Psud, University of Paris-Saclay, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Hôpital européen Georges-Pompidou, APHP, 20 rue Leblanc, 75015, Paris, France.,INSERM, UMRS1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
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Kwon YE, Kim M, Choi S. Degree of interruptions experienced by emergency department nurses and interruption related factors. Int Emerg Nurs 2021; 58:101036. [PMID: 34332454 DOI: 10.1016/j.ienj.2021.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
AIMS This study examined the degree of interruptions experienced by emergency department nurses and related factors. METHODS This study is a descriptive survey using standardized observation tools. A total of 23 nurses working in an emergency department participated in this study. Using a stopwatch over 120 h, the degree of interruptions was investigated by measuring start and end times of tasks and interruptions. Factors related to interruptions were classified as communication, telephone calls, medical device alarms, changes in patient condition, and other factors. RESULTS The frequency of interruptions in the emergency department was 6.4 times per hour, and its percentage was 9.1%. The time required for actual nursing tasks of "counseling and education," "safety," and "patient nursing management and information management" were increased significantly due to interruptions. A primary factor in interruptions was communication with patients, families, and nurses. The longest duration and the highest frequency of interruptions occurred during medication tasks. CONCLUSIONS Communication with patients, families, and nurses was the highest factor related to interruptions. Nurses may cause interruptions and be subjected to interruptions simultaneously. Therefore, nurses in the emergency department should work with caution not to cause interruptions.
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Affiliation(s)
- Yong Eun Kwon
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.
| | - Miyoung Kim
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.
| | - Sujin Choi
- College of Nursing, Woosuk University, Jeonju, Republic of Korea.
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Dilles T, Heczkova J, Tziaferi S, Helgesen AK, Grøndahl VA, Van Rompaey B, Sino CG, Jordan S. Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes. Int J Environ Res Public Health 2021; 18:5973. [PMID: 34199519 PMCID: PMC8199654 DOI: 10.3390/ijerph18115973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 12/13/2022]
Abstract
Pharmaceutical care necessitates significant efforts from patients, informal caregivers, the interprofessional team of health care professionals and health care system administrators. Collaboration, mutual respect and agreement amongst all stakeholders regarding responsibilities throughout the complex process of pharmaceutical care is needed before patients can take full advantage of modern medicine. Based on the literature and policy documents, in this position paper, we reflect on opportunities for integrated evidence-based pharmaceutical care to improve care quality and patient outcomes from a nursing perspective. Despite the consensus that interprofessional collaboration is essential, in clinical practice, research, education and policy-making challenges are often not addressed interprofessionally. This paper concludes with specific advises to move towards the implementation of more interprofessional, evidence-based pharmaceutical care.
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Affiliation(s)
- Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Jana Heczkova
- First Faculty of Medicine, Institute of Nursing Theory and Practice, Charles University, 11000 Prague, Czech Republic;
| | - Styliani Tziaferi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece;
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (A.K.H.); (V.A.G.)
| | | | - Bart Van Rompaey
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Carolien G. Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands;
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea SA2 8PP, Wales, UK;
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Deloison É, Bataille Y, Léon N, Saint-Lorant G. [Reducing mid-task interruptions during medication preparation]. Rev Infirm 2020; 69:41-43. [PMID: 32600597 DOI: 10.1016/s1293-8505(20)30153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nurses are regularly interrupted when performing their tasks. Yet studies have shown that there is a link between the fact of being interrupted when preparing medication and the increased risk of making a mistake. Seeking to reinforce the safety of the medication preparation stage, a team in Normandy studied the benefit, for the nurse, of wearing ear plugs during this specific time.
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Affiliation(s)
- Émilie Deloison
- Pharmacie centrale, centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Yolande Bataille
- Service d'hospitalisation de jour, centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Nathalie Léon
- Service d'hospitalisation de jour, centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Guillaume Saint-Lorant
- Pharmacie centrale, centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France.
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Mortaro A, Pascu D, Pancheri S, Mazzi M, Tardivo S, Bellamoli C, Ferrarese F, Poli A, Romano G, Moretti F. Reducing interruptions during medication preparation and administration. Int J Health Care Qual Assur 2020; 32:941-957. [PMID: 31282257 DOI: 10.1108/ijhcqa-12-2017-0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE According to literature, interruptions during drug administration lead to a significant proportion of medication errors. Evidence on the effectiveness of interventions to reduce interruption is still limited. The purpose of this paper is to explore main reasons for interruptions during drug administration rounds in a geriatric ward of an Italian secondary hospital and test the effectiveness of a combined intervention. DESIGN/METHODOLOGY/APPROACH This is a pre and post-intervention observational study based on direct observation. All nurse staff (24) participated to the study that lead to observe a total of 44 drug dispensing rounds with 945 drugs administered to 491 patients in T0 and 994 drugs to 506 patients in T1. FINDINGS A significant reduction of raw number of interruptions (mean per round from 17.31 in T0 to 9.09 in T1, p<0.01), interruptions/patient rate (from 0.78 in T0 to 0.40 in T1, p<0.01) and interruptions/drugs rate (from 0.44 in T0 to 0.22 in T1, p<0.01) were observed. Needs for further improvements were elicited (e.g. a greater involvement of support staff). PRACTICAL IMPLICATIONS Nurse staff should be adequately trained on the risks related to interruptions during drug administration since routine activity is at high risk of distractions due to its repetitive and skill-based nature. ORIGINALITY/VALUE A strong involvement of both MB and leadership, together with the frontline staff, helped to raise staff motivation and guide a bottom-up approach, able to identify tailored interventions and serve concurrently as training instrument tool.
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Affiliation(s)
- Alberto Mortaro
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Diana Pascu
- Department of Medical Board, Ospedale Girolamo Fracastoro, San Bonifacio, Italy
| | - Serena Pancheri
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Mariangela Mazzi
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Claudio Bellamoli
- Department of Medical, Ospedale Girolamo Fracastoro, San Bonifacio, Italy
| | - Federica Ferrarese
- Department of Medical, Ospedale Girolamo Fracastoro, San Bonifacio, Italy
| | - Albino Poli
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Gabriele Romano
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Francesca Moretti
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
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Soares WE, Price LL, Prast B, Tarbox E, Mader TJ, Blanchard R. Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation. West J Emerg Med 2019; 20:177-184. [PMID: 30643622 PMCID: PMC6324702 DOI: 10.5811/westjem.2018.10.39962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/04/2018] [Accepted: 10/30/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that emergency physicians (EP) frequently encounter. To address interruptions such as ECG interpretation, many EPs engage in task switching, pausing their primary task to address an interrupting task. The impact of task switching on clinical errors in interpreting screening ECGs for STEMI remains unknown. METHODS Resident and attending EPs were invited to participate in a crossover simulation trial. Physicians first completed a task-switching simulation in which they viewed patient presentations interrupted by clinical tasks, including screening ECGs requiring immediate interpretation before resuming the patient presentation. Participants then completed an uninterrupted simulation in which patient presentations and clinical tasks were completed sequentially without interruption. The primary outcome was accuracy of ECG interpretation for STEMI during task switching and uninterrupted simulations. RESULTS Thirty-five participants completed the study. We found no significant difference in accuracy of ECG interpretation for STEMI (task switching 0.89, uninterrupted 0.91, paired t-test p=0.21). Attending physician status (odds ratio [OR] [2.56], confidence interval [CI] [1.66-3.94], p<0.01) and inferior STEMI (OR [0.08], CI [0.04-0.14], p<0.01) were associated with increased and decreased odds of correct interpretation, respectively. Low self-reported confidence in interpretation was associated with decreased odds of correct interpretation in the task-switching simulation, but not in the uninterrupted simulation (interaction p=0.02). CONCLUSION In our simulation, task switching was not associated with overall accuracy of ECG interpretation for STEMI. However, odds of correct interpretation decreased with inferior STEMI ECGs and when participants self-reported low confidence when interrupted. Our study highlights opportunities to improve through focused ECG training, as well as self-identification of "high-risk" screening ECGs prone to error during interrupted clinical workflow.
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Affiliation(s)
- William E. Soares
- University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Lori L. Price
- Clinical and Translational Science Institute, Tufts Medical Center and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center Boston, Massachusetts
| | - Brendan Prast
- University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts
| | - Elizabeth Tarbox
- University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts
| | - Timothy J. Mader
- University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Rebecca Blanchard
- University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts
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