title: Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices.
abstract: OBJECTIVE
  We sought to determine the number of interruptions and to characterize tasks performed in emergency departments compared with those performed in primary care offices.
  
  
  METHODS
  We conducted an observational time-motion, task-analysis study in 5 nonteaching community hospitals and 22 primary care offices in 5 central Indiana cities. Twenty-two emergency physicians and 22 office-based primary care physicians (PCPs) were observed at work. The number of interruptions, tasks, simultaneous tasks, and patients concurrently managed were recorded in 1-minute increments during 150- to 210-minute observation periods.
  
  
  RESULTS
  Emergency physicians were interrupted an average of 9.7 times per hour compared with 3.9 times per hour for PCPs, for an average difference of 5.8 times per hour (95% confidence interval [CI] 4.2 to 7.4). PCPs spent an average of 11.4 minutes per hour performing simultaneous tasks compared with 6.4 minutes per hour for emergency physicians (average difference, 5.0 minutes; 95% CI 1.2 to 8.8). Emergency physicians spent an average of 37.5 minutes per hour managing 3 or more patients concurrently compared with 0.9 minutes per hour for PCPs. PCPs spent significantly more time performing direct patient care, and emergency physicians spent significantly more time in analyzing data, charting, and taking reports on patients.
  
  
  CONCLUSIONS
  Emergency physicians experienced more interruptions and managed more patients concurrently than PCPs. PCPs spent more time performing simultaneous tasks than emergency physicians. Our study suggests there are important ergonomic differences between emergency medicine and office-based primary care work environments that may require different training approaches, design considerations, and coping strategies.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. cchisholm@clarian.com
authors.forename: C D
authors.initials: CD
authors.lastname: Chisholm
authors.forename: A M
authors.initials: AM
authors.lastname: Dornfeld
authors.forename: D R
authors.initials: DR
authors.lastname: Nelson
authors.forename: W H
authors.initials: WH
authors.lastname: Cordell
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D018709:Statistics, Nonparametric; D013996:Time and Motion Studies; D016526:Workload; D017132:Workplace / Q000706:statistics & numerical data*