Workflow interruptions pose threat to patient safety, job satisfaction

Interruptions in a hospital's workflow pose a threat to both job satisfaction and patient safety, according to a column in The Hospitalist.

A big part of the problem is the pressure to multi-task, which author Win Whitcomb, M.D., chief medical officer of Remedy Partners, describes as "task-switching." While some are better at this than others, switching from one activity to another increases the chances of making an error in one of those tasks, he says.

Task-switching also takes valuable time, Whitcomb writes, "[b]ecause changing one's attention from one subject to another involves neurologic processes that are not instantaneous." For example, in a study comparing reaction times between intoxicated drivers and drivers talking on cell phones, "the mean time to brake onset was significantly slower in the cell phone group than in the drunk driving group, presumably because cell phone users had to switch tasks."

While hospitals can't completely eliminate workplace interruptions, there are steps they can take to minimize them at times when remaining on-task is most important, according to the column Whitcomb cites the example of airplane takeoffs and landings, during which unnecessary talking or activity is banned  in the cockpit, suggesting similar "no interruption zones" when hospitalists are developing plans or assessments, or engaged in medication reconciliation.

There are also smaller, more conventional ways to reduce interruptions, he writes, including:

  • Basing staffing around units;

  • Training nurses to page in batches rather than one at a time;

  • Developing "structured evening and night rounds on all nursing units for non-urgent matters;"

  • Multidisciplinary rounds; and

  • Establishing a tier system for paging to alert physicians when and how soon they need to callback.     

"In talking to hospitalists who cite interruptions as job dissatisfiers, it occurs to me that anything that erodes career engagement also threatens patient safety," Whitcomb writes. "If we could figure out how to control interruptions, we would kill two birds with one stone."

A March study found that cell phones are a frequent driver of interruptions in hospital settings, FierceMobileHealthcare previously reported.

To learn more:
- read the column