The nature of the Emergency Department is such that emergency physicians are frequently interrupted as they perform their duties;emergency physicians have been described as "interruption driven". While many of these interruptions are necessary for the emergency department to function effectively, they can also disrupt emergency physician performance resulting in a very serious patient safety risk. Interrupting emergency physicians leads to an increase in error rates, information loss and the amount of time taken to deliver care. Our innovative approach to mitigate the disruptiveness of interruptions is to develop specific cognitive strategies for emergency physicians to employ when interrupted. Cognitive strategies are deliberate actions that the physician can take during an interruption, which will facilitate the resumption process. To develop the strategies, we leverage a theory from the human factors literature that accounts for the cognitive mechanisms underlying task interruption and resumption. By combining this theory, our prior work, and observational data from the emergency department, a set of trainable cognitive strategies that are tailored to the workflow and needs of the physician will be developed.
In Specific Aim 1, we will observe emergency physicians at three different hospitals and document the types of interruptions they encounter as well as the contextual variables surrounding the interruptions. These data will be analyzed for a quantitative understanding of the factors associated with emergency physician interruptions.
Specific Aim 2 will utilize the findings from Specific Aim 1 to adapt and develop specific cognitive strategies that are tailored to the needs of emergency physicians. The descriptions of each cognitive strategy will detail the conditions in which each strategy should be applied and process for applying each strategy. The focus of Specific Aim 3 is developing new simulation-based training modules for emergency physicians to learn and practice the specific cognitive strategies. These modules will be developed such that they can be integrated with existing training programs. At the conclusion of this study we will have developed a set of cognitive strategies for emergency physicians to mitigate the disruptiveness of interruptions in the emergency department. This work will also serve as the basis for a follow-on proposal to evaluate the validity and effectiveness of the training and to adapt the intervention to other domains and healthcare workers such as nurses.

Public Health Relevance

Developing and Training Interruption Management Strategies for Emergency Physicians Project Narrative The overall goal of this project is to develop trainable cognitive strategies for emergency physicians to better handle interruptions. The types of interruptions encountered by emergency physicians will be studied and the data will be used to develop specific strategies for emergency physicians to manage interruptions. Simulation-based training modules will be developed for emergency physicians to learn and practice the strategies. Public Health Relevance intrupting physician performance has been shown to increase errors and increase the time to deliver care. This project is relevant to public health because it has the potential to provide a method for managing interruptions, which will increase patient safety by reducing the disruptiveness of interruptions.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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HSR Health Care Research Training SS (HCRT)
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Burgess, Denise
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Medstar Research Institute
United States
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