Julia Armendariz1, Carla Tamayo2, Justin Slade3, Ilana Belitskaya-Lévy4, Caroline Gray5, Nazima Allaudeen6. 1. At the time of research, was an Internal Medicine Resident, Department of Medicine, Stanford University, and is now an Internal Medicine Physician, Veterans Affairs Palo Alto Health Care System. 2. At the time of research, was an Internal Medicine Resident, Department of Medicine, Stanford University, and is now an Internal Medicine Physician, San Juan, Puerto Rico. 3. At the time of research, was Physician Scholar in Quality and Patient Safety, Medical Service, Veterans Affairs Palo Alto Health Care System, and is now a Cardiology Fellow, Department of Cardiology, The Permanente Medical Group, San Francisco. 4. is a Biostatistician, Cooperative Studies Program Coordinating Center, Veterans Affairs Palo Alto Health Care System. 5. is Research Sociologist, Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System. 6. is Assistant Professor (Affiliated), Stanford School of Medicine, and Director of Quality Improvement, Inpatient Medicine, Veterans Affairs Palo Alto Health Care System.
Abstract
BACKGROUND: Daily attending rounds (AR) are a cornerstone of teaching and patient care in academic health centers. Interruptions in health care are common and can cause increased risk of errors, incomplete work, and decreased decision-making accuracy. Interruptions to AR may diminish a trainee's capacity to learn and retain information. OBJECTIVE: We characterized and quantified interruptions that occur during AR. METHODS: We used a mixed-methods design combining a prospective observational study with a qualitative study. AR were observed January to March 2020 to characterize interruptions, followed by semi-structured interviews with the observed physicians to elucidate the effect of interruptions on workflow and the educational value of rounds. RESULTS: There were 378 observed interruptions over the course of 30 AR sessions, averaging 12.6 (range 1-22, median 13) interruptions per rounding session. Bedside nursing staff was the most common source of interruptions (25%) and consultant recommendations was the most common topic of interruption (21%). Most interruptions occurred during patient presentations (76%), and the most common method of interaction was text message (24%). Most team members described negative effects of interruptions, including loss of focus and missing critical clinical information; some also reported that certain interruptions had positive effects on education and clinical care. Interns were more likely to report negative emotional reactions to interruptions. CONCLUSIONS: AR are frequently interrupted for non-urgent topics by a variety of methods and sources. Negative effects included loss of focus, missed information, and increased stress. Proactive communication, particularly between physicians and nurses, was suggested to reduce interruptions.
BACKGROUND: Daily attending rounds (AR) are a cornerstone of teaching and patient care in academic health centers. Interruptions in health care are common and can cause increased risk of errors, incomplete work, and decreased decision-making accuracy. Interruptions to AR may diminish a trainee's capacity to learn and retain information. OBJECTIVE: We characterized and quantified interruptions that occur during AR. METHODS: We used a mixed-methods design combining a prospective observational study with a qualitative study. AR were observed January to March 2020 to characterize interruptions, followed by semi-structured interviews with the observed physicians to elucidate the effect of interruptions on workflow and the educational value of rounds. RESULTS: There were 378 observed interruptions over the course of 30 AR sessions, averaging 12.6 (range 1-22, median 13) interruptions per rounding session. Bedside nursing staff was the most common source of interruptions (25%) and consultant recommendations was the most common topic of interruption (21%). Most interruptions occurred during patient presentations (76%), and the most common method of interaction was text message (24%). Most team members described negative effects of interruptions, including loss of focus and missing critical clinical information; some also reported that certain interruptions had positive effects on education and clinical care. Interns were more likely to report negative emotional reactions to interruptions. CONCLUSIONS: AR are frequently interrupted for non-urgent topics by a variety of methods and sources. Negative effects included loss of focus, missed information, and increased stress. Proactive communication, particularly between physicians and nurses, was suggested to reduce interruptions.
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