Citations

Interruptions in the emergency department (ED) have been studied across multiple clinical roles, with little investigation into how residents experience interruptions. Therefore this pilot study aimed to characterize interruptions experienced by emergency medicine (EM) residents at various post-graduate year (PGY) levels. Observers shadowed ED residents across entire shifts and logged interruptions that affected clinicians into the Workflow Interruption Tool (WIT). Interruption characteristics captured included duration, nature, location, and task priority. Chi-square analysis identified a significant association between interruption type and the interruption priority, p < 0.001. Residents at varying PGY-levels experienced significantly different amounts of interruptions, p=0.013. Observing resident interruptions across the entirety of their shifts identified that as EM residents gain more experience, they are interrupted more often while working in the ED.

The high uncertainty of the emergency department (ED) and intermittent time-critical activities creates unpredictable staff workloads. Frequent interruptions are inherent to this acute care work environment adding to the demands placed on clinicians. Implementing sustainable interventions to mitigate interruptions has been a challenge. This study examined interruptions in the emergency department and provides a methodology for co-creating interventions to eliminate and/or manage interruptions impact on the care process. Observers collected and categorized interruptions using a validated tablet PC-based tool during clinicians’ entire shifts. Focus groups were used to develop and select provider-centered interventions. A total of 7889 interruptions were identified across 91 shifts. A total of 24 interventions were selected for potential implementation. The interventions were related to (1) protocol, procedures and policy, (2) information sharing, (3) devices and (4) role clarity. Developing sustainable solutions to interruptions has the potential to reduce patients’ vulnerability.

Introduction: Lack of health equity ultimately leads to unequal treatment of diverse patients and contributes to the growing disparities seen in national health. Academic medical centers should consider providing health care providers and biomedical researchers training on how to identify and address health disparities. Methods: The authors led an introductory health disparities course for graduate students and research and clinical fellows at an academic medical center in the Midwest. We compared pre/postcourse assessments to determine changes in learners’ perceptions and knowledge of health disparities using an unpaired analysis to permit inclusion of responses provided only at baseline. Results: Sixty-two learners completed preassessment, with 56 completing the postassessment (90%). In the postcourse assessment, learners reported an increase in knowledge of disparities and had changes in their perceptions of health disparities linked to treatment of different patient groups based on demographic characteristics. There was a statistically significant difference in learners’ perceptions of how patients are treated based on gender identity (P=0.02) and sexual orientation (P=0.04). Conclusions: The results detail how an academic medical center can provide training on health disparities for diverse learners. This study underscores the influence of health disparities from the perspective of learners who conduct biomedical research and patient care. This course serves a model for introductory-level health disparities courses.