Abstract: 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 critical in... read moreterruptions. 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 needed.
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