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An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments
Karolinska University Hospital; Karolinska Institutet.ORCID-id: 0000-0003-1815-799x
Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.ORCID-id: 0000-0002-3964-196X
Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
Vise andre og tillknytning
2012 (engelsk)Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 19, nr 4, s. 246-251Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.

Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.

Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.

Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

sted, utgiver, år, opplag, sider
London: Chapman & Hall , 2012. Vol. 19, nr 4, s. 246-251
Emneord [en]
activities; Emergency Service hospital; medical errors; multitasking; nurse clinicians; observations; patient safety; physicians
HSV kategori
Forskningsprogram
Hälsa och välfärd, ”Många bollar i luften” – Personalens arbetsmiljö på akutmottagning.
Identifikatorer
URN: urn:nbn:se:du-5745DOI: 10.1097/MEJ.0b013e32834c314aISI: 000305896600009PubMedID: 21934505Scopus ID: 2-s2.0-84863580012OAI: oai:dalea.du.se:5745DiVA, id: diva2:520404
Tilgjengelig fra: 2011-08-31 Laget: 2011-08-31 Sist oppdatert: 2021-11-12bibliografisk kontrollert
Inngår i avhandling
1. Patient safety at emergency departments: challenges with crowding, multitasking and interruptions
Åpne denne publikasjonen i ny fane eller vindu >>Patient safety at emergency departments: challenges with crowding, multitasking and interruptions
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Several challenges with patient safety in the emergency department (ED) context have beenpreviously identified, and some commonly mentioned are crowding, multitasking, andinterruptions. The ED is a complex, high-risk work environment where multiple clinicians(physicians, registered nurses [RNs], and licensed practical nurses [LPNs]) are constantlyworking in parallel work processes, in an often crowded ED, while conducting tasksinvolving cognitively demanding decision-making processes. ED crowding has for the past20 years been identified as a problem internationally, resulting in extended ED length of stay(LOS) and increased morbidity and mortality for patients. ED crowding is also considered tohave negative effects on the clinicians' workload and work satisfaction.

Both multitasking and interruptions have been identified as risk factors for patient safety byhaving negative effects on a clinician's decision-making processes and thus increasing therisk of forgetting important details and events because of memory overload. However,information has been lacking about what specific work assignments ED clinicians conduct,and thus there is little information about the types of assignments they perform whilemultitasking and being exposed to interruptions. Further, because not all interruptions lead toerrors and because they are not all preventable, a more refined account of interruptions iscalled for. Moreover, it seems that previous studies have not identified which specific factorsinfluence the ED clinicians' perceptions of interruptions. The work environment has beenreferred to as a possible influencing factor, but specific details on the relationship between thework environment and negative effects from interruptions are pending.

The overall aim of the thesis was to describe ED crowding, and its influence on EDclinicians' work processes (activities, multitasking, and interruptions) and patient outcomes,from a patient safety perspective. The thesis addressed six research questions: 1) How has EDcharacteristics, patient case mix and occurrence of ED crowding changed over time? 2) Whatwork activities are performed by ED clinicians? 3) What kind of multitasking situations areclinicians exposed to during ED work? 4) What kind of interruptions are clinicians exposedto during ED work? 5) How do ED clinicians perceive interruptions? 6) Is there anassociation between ED crowding and mortality for stable patients without the need for acutehospital care upon departure from the ED?

The data in the thesis were generated from two data collections: 1) registry data containingpatient characteristics and measures of ED crowding (ED occupancy ratio [EDOR], ED LOS,and patient/clinician ratios) extracted from the patients' electronic health records (paper I andIV) and 2) observations and interviews with ED clinicians (physicians, RNs, and LPNs)(paper II and III). Nonparametric statistics were used in paper I and III, quantitative and qualitative content analysis were used in paper II and III, and multivariate logistic regressionanalysis was used in paper IV.

The main results in the thesis are presented based on Asplin's conceptual model of EDcrowding, from the aspect of input-throughput-output, and how parts of a sub-optimalthroughput influence patient safety through ED clinicians' work processes and patientoutcomes. During 2009 – 2016 there has been a change in patient case mix at the EDs at thestudy hospital, primarily with an increase in unstable patients (input) and a decrease in thenumber of patients admitted to in-hospital care (output). The median for ED LOS over thestudy period increased, and the largest increases occurred among the subgroups of unstablepatients, patients ≥80 years of age, and those admitted to in-hospital care (throughput).Further, an increase in crowding, in terms of median EDOR and median patients per RNratios, was identified, with an increase in EDOR from 0.8 in 2009 to 1.1 in 2016 and anaverage increase of 0.164 patients/RN/year (throughput). The ED clinicians' workassignments consisted of 15 categories of activities, and information exchange was found tobe the most common activity (42.1%). In contrast, the clinicians only spent 9.4% of theiractivities on direct interaction with patients and their families (ED clinicians' workprocesses). The clinicians multitasked during 23% of their total number of performedactivities, and there was an overall interruption rate of 5.1 interruptions per hour. Themajority of the observed multitasking situations and interruptions in the ED clinicians' workoccurred during demanding activities that required focus or concentration (ED clinicians'work processes). Finally, an association was identified between an increase in ED LOS andEDOR and 10-day mortality for stable patients without the need for acute hospital care upondeparture from the ED (patient outcomes).

This thesis illustrates how a sub-optimal throughput, affected by conditions in both the inputand output components, negatively influence the ED clinicians' work processes as well aspatient outcomes.

sted, utgiver, år, opplag, sider
Stockholm: Karolinska Institutet, Dept of Medicine, Solna, 2018
HSV kategori
Identifikatorer
urn:nbn:se:du-35003 (URN)978-91-7549-892-8 (ISBN)
Disputas
2018-12-14, Rolf Luft, L1:00, Anna Steckséns gata 53, Karolinska University Hospital, Solna, 09:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2020-09-18 Laget: 2020-09-18 Sist oppdatert: 2020-09-18bibliografisk kontrollert

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