An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments

Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
European Journal of Emergency Medicine (Impact Factor: 1.58). 09/2011; 19(4):246-51. DOI: 10.1097/MEJ.0b013e32834c314a
Source: PubMed


To explore the type and frequency of activities and multitasking performed by emergency department clinicians.
Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.
Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses' and doctors' offices were the most common locations for multitasking in the emergency department.
This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

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    • "Specifically vulnerable areas include patient flow, work-load, communication, information technology, assignments of responsibility and environment. In addition, the working environment, which demands constant multitasking, is a challenge [12]. System-based interventions may prevent many of these adverse events and consequently improve patient safety [9,13]. "
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    ABSTRACT: Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.
    Full-text · Article · Jul 2014 · BMC Health Services Research
    • "The authors also conclude that RNs were the professional group who performed the majority of the multitasking activities (Berg et al., 2012). Thus, the phenomenon of multitasking is known in EDs. "
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    ABSTRACT: • The findings from this study showed registered nurses' positive perceptions regarding their work, where multitasking was seen as an attractive prerequisite, implying efficiency and not stressful. • Respondents didn't perceive multitasking as related to an increase risk of error. However, the participants expressed their worries about new inexperienced colleagues and other colleagues not managing stressful multitasking situations. • The results from this study show that from the nurses' perspective, multitasking is perceived as a main characteristic of work in the ED. • This study shows how the patient load and the unreflected multitasking that follows relates to nurses' perceived efficiency and job satisfaction.
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    ABSTRACT: Objective: Frequent interruptions are assumed to have a negative effect on healthcare clinicians' working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments. Method: Totally 18 clinicians, licensed practical nurses, registered nurses and medical doctors, at two Swedish emergency departments were observed during clinical work for 2 h each. A semistructured interview was conducted directly after the observation to explore their perceptions of interruptions. Data were analysed using non-parametric statistics, and by quantitative and qualitative content analysis. Results: The interruption rate was 5.1 interruptions per hour. Most often the clinicians were exposed to interruptions during activities involving information exchange. Calculated as percentages of categorised performed activities, preparation of medication was the most interrupted activity (28.6%). Face-to-face interaction with a colleague was the most common way to be interrupted (51%). Most common places for interruptions to occur were the nurses' and doctors' stations (68%). Medical doctors were the profession interrupted most often and were more often recipients of interruptions induced by others than causing self-interruptions. Most (87%) of the interrupted activities were resumed. Clinicians often did not regard interruptions negatively. Negative perceptions were more likely when the interruptions were considered unnecessary or when they disturbed the work processes. Conclusions: Clinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.
    No preview · Article · Apr 2013 · BMJ quality & safety
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