title: Emergency physicians' behaviors and workload in the presence of an electronic whiteboard.
abstract: BACKGROUND
  As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the emergency department (ED) and it is time to begin understanding how these systems are effecting physician behavior, communication and workload.
  
  
  METHODS
  The study used a time-in-motion, primary task analyses to study faculty and resident physician behavior in the presence of an electronic whiteboard. The NASA-Task Load Index (TLX) was used to measure subjective workload and the underlying dimensions of workload at the end of each physician observation. Work, communication and workload were characterized using descriptive statistics and compared using Mann-Whitney U-tests.
  
  
  RESULTS
  Physicians in our study performed more tasks and were interrupted less than physicians studied previously in conventional EDs. Interruptions interrupted direct patient care tasks less than other clinical activities. Temporary interruptions appear to be a major source of inefficiency in the ED, and likely a major threat to patient safety. Face-to-face interruptions persist even in the presence of advanced IT systems, such as the electronic whiteboard. Faculty physicians exhibited lower workload scores than resident physicians. Frustration was a significant contributing factor to workload in resident physicians. All physicians ranked temporal demands and mental demands as major contributing factors to workload.
  
  
  CONCLUSIONS
  The results indicate that the electronic whiteboard improves the efficiency of work and communication in the ED. IT solutions may have great utility in improving provider situational awareness and distributing workload among ED providers. The results also demonstrate that IT solutions alone will not solve all problems in the ED. IT solutions will probably be most effective in improving efficiency and safety outcomes when paired with human-based interventions, such as crew resource management. Future studies must investigate team interaction, workload and situational awareness, and the association of these factors to patient and provider outcomes.
authors.affiliation: Vanderbilt University Medical Center, Department of Medicine, S1108 Medical Center North, Nashville, TN 37232-2668, USA. dan.france@vanderbilt.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.forename: Scott
authors.initials: S
authors.lastname: Levin
authors.forename: Robin
authors.initials: R
authors.lastname: Hemphill
authors.forename: Kong
authors.initials: K
authors.lastname: Chen
authors.forename: Dorsey
authors.initials: D
authors.lastname: Rickard
authors.forename: Renee
authors.initials: R
authors.lastname: Makowski
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
mesh_terms: D004581:Electronics; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D010561:Personnel Staffing and Scheduling; D010817:Physician-Patient Relations; D010820:Physicians; D012449:Safety; D013647:Task Performance and Analysis; D017748:Time Management; D014584:User-Computer Interface; D000078329:Workforce; D016526:Workload