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Interruptions in the workplace have nurses stressed
Study looks at ED workflow interruptions and their impact
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By Lisette Hilton
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1. Educate ED staff members
“The nurses need to be aware of how the small interruptions can significantly influence their mental workload and productivity during patient care and EMR documenting activities,” Kim wrote. Nurses should be trained to respond these small interruptions, according to Kim. For example, ED nurses should avoid answering questions or non-emergency phone calls while delivering direct care to patients and while engaged in EMR documentation. And patients’ relatives should allow nurses and other healthcare workers to perform critical duties without interruption.
2. Use EMR bookmarks
3. Control ED workflow
Interruptions might be part of the job in an emergency department, but they can take a toll on nurses and patients. 
“Maybe that should be a 30-minute period that’s interruption free, unless it’s a life or death situation,” he said. Because that’s one of the times when you’re conveying a lot of information in a short period of time and don’t want constant interruptions to happen.” McNeely said he prefers to do his EMR documentation and charting at patients’ bedsides — away from busy common areas. And he tries not to put any of the tasks he needs to do aside; rather, he finishes one task before starting another.
EDITOR'S NOTE: Lisette Hilton is a freelance writer.
“The nurses need to be aware of how the small interruptions can significantly influence their mental workload and productivity during patient care and EMR documenting activities.” — Jung Hyup Kim, PhD
Kim and colleagues recommended providing visual retrieval cues in EMR systems, such as small thumbnail images of prior suspended activity, that could positively influence the nurses to reconstruct the mental context of what they did in the past.
John McNeely, BSN, RN, CEN, understands this dilemma. After arriving home from his shifts at the University of Missouri Hospital in Columbia, sometimes he needs to decompress and enjoy some silence — no TV, radio, just peace and quiet.
“There are days when there is this constant cacophony of stuff that goes on,” he said. “While you’re trying to concentrate on charting for one patient, the alarm is going off for another or the call light is going on, or the phone is ringing. The mental taxation, I think, is often worse than the physical exhaustion.” A recent study investigating the impact of interrupting ED nurses’ mental workloads by researchers at the University of Missouri found workflow interruptions are most likely to occur during electronic medical record documentation and direct patient care. The five most common interruptions to the nurses' work included phone calls, colleagues, residents, physician requests and patient relatives.
“In this study, we provided the detailed quantitative analysis of how external interruptions, such as phone calls, colleagues, residents, doctors or patients’ family members, influence [ED] nurses’ workload,” the study’s lead author, Jung Hyup Kim, PhD, assistant professor of Industrial and Manufacturing Systems Engineering at University of Missouri, wrote in an email to Nurse.com.
Kim and his team traveled to the Mayo Clinic in Rochester, Minn., to study how brief interruptions affected nurses in the emergency department. They used their findings to create two simulation models — one illustrating workflow efficiency without interruption and another showcasing potential effects of interruptions on tasks. Among their findings — ED nurses’ mental workloads were 2.04 times higher during patient care activities and 4.72 times higher during EMR charting in the interruption model compared to the non-interruption model. The researchers suggested three tips for reducing nurses’ ED stress, according to Kim. 
Today’s EDs aren’t designed to prevent what Kim called “nested interruption.” By controlling ED workflow, he said, such as providing sensor-driven interruption awareness displays, delaying self-initiated disruptions, or preventing multitasking, the occurrence of the nested interruptions would be minimized. Christopher Sampson, MD, an emergency department physician at University of Missouri Health Care in Columbia, said interruptions often occur during nurse shift changes, when documenting patients’ information without interruption is important for accuracy.  “Maybe that should be a 30-minute period that’s interruption free, unless it’s a life or death situation,” he said. Because that’s one of the times when you’re conveying a lot of information in a short period of time and don’t want constant interruptions to happen.” McNeely said he prefers to do his EMR documentation and charting at patients’ bedsides — away from busy common areas. And he tries not to put any of the tasks he needs to do aside; rather, he finishes one task before starting another.
Today’s EDs aren’t designed to prevent what Kim called “nested interruption.” By controlling ED workflow, he said, such as providing sensor-driven interruption awareness displays, delaying self-initiated disruptions, or preventing multitasking, the occurrence of the nested interruptions would be minimized.
Christopher Sampson, MD, an emergency department physician at University of Missouri Health Care in Columbia, said interruptions often occur during nurse shift changes, when documenting patients’ information without interruption is important for accuracy. 
John McNeely, RN
Jung Hyup Kim
Christopher Sampson
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