Emergency Physicians’ Workstation Design: An Observational Study of Interruptions and Perception of Collaboration During Shift-End Handoffs

Abstract

Background: Frequent external interruptions and lack of collaboration among team members are known to be common barriers in end-of-shift handoffs between physicians in the emergency department. In spite of being the primary location for this crucial and cognitively demanding task, workstations are not designed to limit barriers and support handoffs. Objective: The purpose of this study is to examine handoff characteristics, actual and perceived interruptions, and perceived collaboration among emergency physicians performing end-of-shift handoffs in physician workstations with varying levels of enclosures—(a) open-plan workstation, (b) enclosed workstation, and (c) semi-open workstation. Method: Handoff and interruption characteristics were captured through in-person observations of 60 handoffs using an iPad-based tool. Additionally, physicians participating in the handoffs responded to a survey pertaining to their perception of interruptions and collaboration with clinicians during each phase. Other organizational and demographic data were obtained from the hospital database, surveys, and observations. Results: Physicians working in the open workstation experienced a significantly higher number of interruptions/hour (18.08 int/hr) as compared to the semi-open (13.62 int/hr) and enclosed workstations (11.41 int/hr). Most physicians perceived that they were interrupted in the semi-open and open workstations. In addition, majority of physicians in the enclosed pod perceived high collaboration with clinicians involved in and present in the workstation during handoff. Conclusion: This correlational study showed positive outcomes experienced by physician working in the enclosed workstation as compared to the open and semi-open workstations.

Coping and Caregiving: Leveraging Environmental Design to Moderate Stress Among Healthcare Workers in the Emergency Department Setting

“…Physical environmental strategies suggested to mitigate interruptions go hand in hand with improving privacy, including developing “no interruption” zones or quiet rooms locating medication dispensing machines in closed versus open areas (Chaudhury et al, 2009), designing enclosed physician workstations (Joshi et al, 2021), and incorporating private workspaces as well as glass partitions between care team areas (Gunn et al, 2015). Despite a high emphasis on teamwork, collaboration, and communication in healthcare design literature (Morley & Cashell, 2017; Schneider, 2012), findings about high levels of interruptions and their negative consequences in the healthcare environments (Blocker et al, 2017; Monteiro et al, 2015) call for revisiting open work environments and seeking solutions that achieve a balance between collaboration and concentration.…”

Measuring Potential Visual Exposure of Physicians During Shift-End Handoffs and Its Impact on Interruptions, Privacy, and Collaboration

“…As defined by Ratwani and colleagues (2017), any event initiated by an outside stimulus requiring the physician to direct his or her attention away from the current task was considered an interruption. An iPad-based template was created to observe and capture the number and sources of face-to-face interruptions (Table 3) experienced by physicians during each phase of the handoff (details provided in Joshi et al, 2021).…”

“…A handoff between an outgoing and incoming physician typically includes four phases—(a) handoff preparation, (b) arrival, (c) exchange and dialogue, (d) post-handoff (Cheung et al, 2010; Wears et al, 2004). During handoffs, physicians engage in focused tasks such as computer work to interpret reports, place medication or lab orders, and dictate notes (Fong & Ratwani, 2018; Joshi et al, 2021). Collaborative tasks include answering phone calls and face-to-face communication with clinicians involved in the handoff until a “mutually satisfactory and contextually appropriate degree of understanding” is reached about the patient cases (Cheung et al, 2010; Fong & Ratwani, 2018; Joshi et al, 2021; Perry et al, 2008; Wears et al, 2003).…”

“…During handoffs, physicians engage in focused tasks such as computer work to interpret reports, place medication or lab orders, and dictate notes (Fong & Ratwani, 2018; Joshi et al, 2021). Collaborative tasks include answering phone calls and face-to-face communication with clinicians involved in the handoff until a “mutually satisfactory and contextually appropriate degree of understanding” is reached about the patient cases (Cheung et al, 2010; Fong & Ratwani, 2018; Joshi et al, 2021; Perry et al, 2008; Wears et al, 2003). Both individual and collaborative tasks are crucial in ensuring a safe and complete handoff.…”

“…Previous studies in the ED recorded 6–19 interruptions per hour during a regular physician shift (Allard et al, 2012; Blocker et al, 2017; Fong et al, 2014; Ratwani et al, 2017). To date, however, only two studies have documented interruptions during emergency physician handoffs (Joshi et al, 2021; Thompson et al, 2018), and one such study explores emergency resident handoffs (Peterson et al, 2014). Joshi and colleagues (2021) recorded that emergency physicians were interrupted 11.06 times/hour, Thompson and colleagues (2018) recorded that physicians were interrupted 7.05 times/hour, and Peterson and colleagues (2014) reported that residents were interrupted 11.7 times/hour during the exchange and dialogue phase of handoffs.…”