Task Switching and Accuracy of Rapid Electrocardiogram screening for ST-Elevation Myocardial Infarction by Emergency Medicine Providers.
Interruptions are frequent in healthcare and are thought to contribute to medical
errors. However, pausing workflow to address clinically significant interruptions, known
as task switching, is an important aspect of emergency care. While prior studies have
focused on primary task errors, no study has evaluated the association of task switching
on accuracy of interpretation of critic... read moreal interruptions. A quasi-experimental trial
utilizing task switching and uninterrupted simulations was created. Participants first
completed a task-switching module, viewing patient presentations with clinical
interruptions requiring interpretation every minute. Participants then completed an
uninterrupted module, in which patient presentations and clinical stimuli were completed
sequentially and without interruption. The primary outcome was the percent of
electrocardiograms (ECGs) correctly interpreted for ST elevation myocardial infarction
(STEMI) during the task-switching module compared to uninterrupted module. Overall, 35
emergency providers completed the study. There was no significant difference in mean
percent correct (accuracy) of ECG interpretation for STEMI in the task-switching
scenario compared with the uninterrupted scenario (Mean 0.89, 0.91 respectively, Paired
T test p=0.21). Logistic regression using generalized estimating equations revealed
attending physician status (OR 2.56, CI 1.66-3.94, p<0.01) and inferior STEMI (OR
0.08, CI 0.04-0.14, p<0.01) were associated with increased and decreased odds of
correct ECG interpretation, respectively. Further, self reported confidence was
associated with increased odds of correct ECG interpretation in the task-switching
module, but not in the uninterrupted module. (Interaction p=0.02) Results suggest that
not all interruptions lead to error; factors such as provider experience, type of
interruption and confidence in interpretation all influence the probability of error.
Further research, both to identify factors associated with medical errors interpreting
interruptions as well as strategies to avoid errors is
Thesis (M.S.)--Tufts University, 2015.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Rebecca Blanchard.
Committee: Timothy Mader, and Lori Lyn Price.
Keywords: Health sciences, and Health education.read less