Understanding Emergency Medicine Physicians Multitasking Behaviors Around Interruptions

Fong, Allan; Ratwani, Raj M.

doi:10.1111/acem.13496

Cited by 26 publications

(28 citation statements)

References 18 publications

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“…Information systems are needed to support complex tasks related to communication and care coordination. [1][2][3][4] The implementation of computerized health information systems in emergency medicine (EM) has led to new opportunities for task support but has also created new challenges, in part due to shortcomings in design which impact the usability and usefulness of these systems. [5][6][7] Health information technology (IT) has improved legibility issues, historical information access, and data sharing capabilities.…”

Section: Background and Significancementioning

confidence: 99%

Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine

et al. 2019

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Background Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. Objective This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. Methods ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed. Results Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire—mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives. Conclusion A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.

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Section: Background and Significancementioning

confidence: 99%

Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine

et al. 2019

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“…In this issue, Fong and Ratwani take a new look of the perennial question of the role of interruptions and multitasking in emergency department (ED) work. They propose a framework that extends basic concepts of interruptions to a more clinically relevant set of ideas.…”

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confidence: 99%

“…Another fundamental part of understanding the disruptive nature of ED work is how to define those aspects, such as interruptions, in a way that makes sense in the medical context, and this is the issue that Fong and Ratwani tackle directly . There are almost as many definitions of interruptions in health care as there are studies on the subject.…”

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confidence: 99%

“…Much of the variation in definitions of interruptions in health care may stem from trying to make some version of Trafton's definition fit a more complex and often ambiguous set of behaviors. And this is where Fong and Ratwani have tried to build in some complexity to the interruption concept to make it more context appropriate. It has been suggested that definitions must necessarily be developed specifically for each study since observations of clinical work require precise operational definitions for reliable data collection—a corollary of which is that universal concepts are not particularly useful .…”

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confidence: 99%

“…Given the uniqueness of both the setting and the aims of studying ED work, it is reasonable, and perhaps essential, to move on from historical terminology, concepts, and hypotheses, especially in light of the limited progress we have made in understanding clinical work. Fong and Ratwani have importantly revisited this conversation and have given us a timely opportunity to radically rethink the way we study ED work. This is a fundamental area of health care quality and being at the intersection of many disciplines means we can harness and build on multiple research paradigms .…”

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confidence: 99%

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