Background

The fast-paced and rapidly changing environment of an Emergency Department (ED) requires providers to have a high level of situation awareness (SA). However, acute clinical care also encompasses a multitude of interruption-laden work processes that might degrade SA. It is therefore important to understand how frequent interruptions affect ED provider cognition in general and SA in particular.

Objective

We aimed to examine how sources and contents of provider workflow interruptions influence situation awareness of ED physicians and nurses.

Methods

This prospective, multi-method study combined standardized observations, self-reports of ED providers, and ED administrative data of staffing and patient load. Expert observers identified ED providers’ workflow interruptions during 90min observation sessions. Afterwards, each provider reported perceived disruptiveness and situation awareness. Controlling for patient load, patient acuity and staffing, we conducted regression analyses to explore prospective associations between interruptions and provider outcomes.

Results

During 74 observation sessions of overall 110h and 40min, we observed 1205 workflow interruptions (mean rate: 10.9 interruptions/hour). Provider situation awareness was fairly high (M = 7.10; scale 0–10) with no difference between ED physicians and nurses. After controlling for ED workload data, we observed that high rates of interruptions were associated with lower levels of situation awareness (β = −0.27). Further analyses revealed that particularly interruptions by telephone/beeper, technical malfunctions as well as interruptive communication related to completed cases were correlated to low SA.

Discussion

This study in a naturalistic ED setting shows that ED physicians and nurses continuously cope with disruptions and interruptions. Our findings reveal that highly interruptive workflow environments impede providers' situation awareness. Moreover, it sheds light on specific sources and contents of interruptions that influence providers’ SA in acute care.

Conclusion

Frequent workflow interruptions can degrade ED providers’ situation awareness. A deeper understanding of how avoidable and unavoidable interruptions affect provider cognitions with particular focus on social and technology-related disruptions is required. Further emphasis should be placed on the effective application of work re-design in this context to foster safe and efficient patient care.

中文翻译：

---

急救中的工作流程中断和提供者处境意识：与急诊科医师和护士进行的观察性研究。

背景

急诊室（ED）的快速节奏和快速变化的环境要求提供者具有高度的态势感知（SA）。但是，急性临床护理还包括大量可能使SA降级的中断工作流程。因此，重要的是要了解频繁的打扰如何影响ED提供商的整体认知，尤其是SA。

目的

我们旨在检查提供者工作流程中断的来源和内容如何影响急诊医师和护士的情况意识。

方法

这项前瞻性，多方法的研究结合了标准化的观察结果，ED提供商的自我报告以及ED的人员配备和患者负担管理数据。专家观察员在90分钟的观察期间确定了ED提供商的工作流程中断。之后，每个提供者都报告了感知到的破坏性和态势感知。在控制患者负担，患者敏锐度和人员配备方面，我们进行了回归分析，以探讨中断与提供者结果之间的预期关联。

结果

在总共110h和40min的74次观察期间，我们观察到1205个工作流中断（平均速率：10.9个中断/小时）。提供者处境意识很高（M = 7.10；等级0-10），ED医师和护士之间没有差异。在控制了ED工作量数据之后，我们观察到较高的中断率与较低水平的态势感知有关（β= -0.27）。进一步的分析表明，特别是电话/蜂鸣器的中断，技术故障以及与已完成案件有关的干扰性沟通均与低SA相关。

讨论区

这项研究是在自然主义的ED环境中进行的，表明ED医师和护士不断地应对干扰和干扰。我们的发现表明，高度中断的工作流程环境会阻碍提供商的处境意识。而且，它揭示了影响供应商急诊服务提供商SA的特定中断源和内容。

结论

频繁的工作流中断会降低ED供应商的状况意识。需要对可避免和不可避免的中断如何影响提供者的认知有更深入的了解，尤其要关注与社会和技术相关的中断。在这种情况下，应进一步强调有效的工作重新设计，以促进安全和有效的患者护理。