title: Emergency doctors' strategies to manage competing workload demands in an interruptive environment: An observational workflow time study.
abstract: An observational workflow time study was conducted involving doctors in the emergency department (ED) of a large Australian hospital. During 121.7 h across 58 sessions, we observed interruptive events, conceptualised as prompts, and doctors' strategies to handle those prompts (task-switching, multitasking, acknowledgement, deferral and deflection) to assess the role of multiple work system factors influencing doctors' work in the ED. Prompt rates varied vastly between work scenarios, being highest during non-verbal solo tasks. The propensity to use certain strategies also differed with task type, prompt type and location within the department, although task-switching was by far the most frequent. Communicative prompts were important in patient treatment and workload management. Clinicians appear to adjust their communication strategies in response to contextual factors in order to deliver patient care. Risk due to the interruptive nature of ED communication is potentially outweighed by the positive effects of timely information transfer and advice provision.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. Electronic address: scott.walter@mq.edu.au.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Walter
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: Magdalena Z
authors.initials: MZ
authors.lastname: Raban
authors.affiliation: School of Mathematics and Statistics, Faculty of Science, University of New South Wales, Sydney, Australia.
authors.forename: William T M
authors.initials: WTM
authors.lastname: Dunsmuir
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Douglas
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D001519:Behavior; D003142:Communication; D003463:Cues; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D010820:Physicians / Q000523:psychology; D013996:Time and Motion Studies; D057188:Workflow; D016526:Workload
keywords: Clinical work systems; Emergency medicine; Interruption; Multitasking; Task-switching