Interruptions: more toxic than sleep deprivation?

John Nelson writes…

There are two big events in the news as I write: the US Air plane that went down in the Hudson, and Obama’s inauguration.  It is tough to resist a long commentary on both.   After all, I read more than one newspaper and some on-line news sites which of course makes me an authoritative pundit on politics.  And I’m a pilot (little single-engine prop planes) who, like Sully Sullenberger, has guided a wounded plane without a functioning engine to a landing in which all aboard were unhurt.  (OK, I was pilot and sole occupant of the plane when the engine quit, so I’m being facetious when I compare it to the heroic US Air landing.)  But I’m also smart enough to realize you have access to sources of information much better than me on both of these topics.

So instead, I’ll briefly talk about what I see as increasing interest in hospitalist interruptions.  I will briefly review my thoughts here, and if you’re interested in a little more detail have a look at the article I wrote for the November issue of The Hospitalist.

Hospitals become busier places every year.  The typical nursing station has changed from feeling like a quiet and sedate library years ago, to the noisy and boisterous feel of the trading floor of a commodities market.  With this change all caregivers are interrupted more often.  But among doctors, I think hospitalists, ER doctors, and radiologists probably have the most frequent and high volume interruptions.  These disruptions to our train of thought may come in the form of another person walking up and starting a conversation, or more painfully for me, a page delivered by a beeper or cell phone.

I’ve often thought of this rising tide of interruptions requires us to become excellent multitaskers and parallel processors.  But some people think we’re just fooling ourselves into believing we can multitask effectively.  Instead we’re really “switchtasking,” meaning we do one thing at a time but switch tasks so often that it just feels like multitasking.

Kevin O’Leary and his colleagues at Northwestern shadowed hospitalists and found that they were interrupted by pages an average of 3.4 times per hour.  And other studies have shown that once interrupted, doctors often fail to return to complete the task they engaged in prior to the interruption.

All this research, combined with my own experience, makes me think that interruptions may be a bigger problem, and lead to more errors, than sleep deprivation and other such issues that are getting a lot of attention in the lay and medical press lately.

Reducing interruptions isn’t easy.  Order sets, paging protocols (e.g., try to avoid using a triage pager), and unit-based hospitalist assignment are of some benefit.   But I think every practice should devote some time and attention to limit interruptions, prioritize them, and reduce their adverse impact.  I haven’t figured out the best practices in this regard, but with the accumulated experience of our field I think we will get this figured out.

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