Brixey Juliana J, Tang Zhihua, Robinson David J, Johnson Craig W, Johnson Todd R, Turley James P, Patel Vimla L, Zhang Jiajie
University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
Int J Med Inform. 2008 Apr;77(4):235-41. doi: 10.1016/j.ijmedinf.2007.04.006. Epub 2007 Jun 14.
The emergency department has been characterized as interrupt-driven. Government agencies and patient safety organizations recognize that interruptions contribute to medical errors. The purpose of this study was to observe, record, and contextualize activities and interruptions experienced by physicians and Registered Nurses (RNs) working in a Level One Trauma Center.
A case study that relied on an ethnographic study design using the shadowing method.
A convenience sample of physicians and RNs, each with at least 6 months of experience in the Emergency Department (ED), were asked to participate. In these kinds of detailed qualitative investigations, it is quite common to have a small sample size. Ethical approval: Approval was obtained from institutional ethic committees prior to initiating the study. Community consent was obtained from the ED staff through in-service education.
All observations were made in the trauma section of the ED of a tertiary teaching hospital. The hospital is situated in a major medical center in the Gulf Coast region of the United States of America (USA).
Five attending ED physicians were observed for a total of 29h, 31min. Eight RNs were shadowed for a total of 40 h, 9min. Interruptions and activities were categorized using the Hybrid Method to Categorize Interruptions and Activities (HyMCIA). Registered Nurses received slightly more interruptions per hour than physicians. People, pagers, and telephones were identified as mediums through which interruptions were delivered. The physical environment was found to contribute to interruptions in workflow because of physical design and when supplies were not available. Physicians and RNs usually returned to the original, interrupted activity more often than leaving the activity unfinished.
This research provides an enhanced understanding of interruptions in workflow in the ED, the identification of work constraints, and the need to develop interventions to manage interruptions. It is crucial that interruptions be delivered in such a way that there is minimal negative impact on performance. The significance and importance of the interruption must always be weighed against the negative impact that it has on smooth, efficient workflow.
急诊科的特点是工作常被打断。政府机构和患者安全组织认识到，工作中断会导致医疗差错。本研究的目的是观察、记录并分析在一级创伤中心工作的医生和注册护士（RN）所经历的活动及工作中断情况。
一项采用跟随观察法的人种志研究设计的案例研究。
选取了在急诊科（ED）至少有6个月工作经验的医生和注册护士作为便利样本参与研究。在这类详细的定性研究中，样本量较小是很常见的。伦理批准：在研究开始前获得了机构伦理委员会的批准。通过在职教育获得了急诊科工作人员的社区同意。
所有观察均在一家三级教学医院急诊科的创伤区进行。该医院位于美国（USA）墨西哥湾沿岸地区的一个主要医疗中心。
共观察了5名急诊科主治医生，总计29小时31分钟。对8名注册护士进行了跟随观察，总计40小时9分钟。使用中断和活动分类混合方法（HyMCIA）对中断和活动进行分类。注册护士每小时受到的干扰略多于医生。人员、传呼机和电话被确定为干扰传递的媒介。由于物理设计和物资短缺，发现物理环境会导致工作流程中断。医生和注册护士通常比未完成活动更频繁地回到原来被中断的活动中。
本研究有助于更深入地了解急诊科工作流程中的中断情况、识别工作限制因素以及开发管理中断的干预措施的必要性。至关重要的是，应以对工作表现负面影响最小的方式传递中断信息。必须始终权衡中断的重要性和意义与其对顺畅、高效工作流程的负面影响。
