Developing and Training Interruption Management Strategies for Emergency Physicia

项目总结/摘要 急诊科的性质是急诊医生经常被打断，因为他们 履行职责;急诊医生被描述为“中断驱动”。虽然其中许多 中断是必要的急诊科有效运作，他们也可以扰乱 急诊医生的表现导致非常严重的患者安全风险。中断紧急情况 医生之间的沟通导致错误率、信息丢失和提供护理所需时间的增加。 我们的创新方法，以减轻中断的破坏性是发展特定的认知 急诊医生在中断时的策略。认知策略是深思熟虑的行动 医生可以在中断期间服用，这将有助于恢复过程。发展 战略，我们利用理论，从人的因素文献，占认知机制 基本任务中断和恢复。通过结合这一理论，我们先前的工作和观测数据， 从急诊科，一套可训练的认知策略，是量身定制的工作流程， 医生的需求将得到发展。在具体目标1中，我们将观察急诊医生， 不同的医院，并记录他们遇到的中断类型以及上下文变量 围绕着中断。将对这些数据进行分析，以便定量了解这些因素 与急诊医生的打扰有关。具体目标2将利用具体目标1的发现， 调整和发展特定的认知策略，以适应急诊医生的需求。的 对每种认知策略的描述将详细说明每种策略应适用的条件， 每个战略的实施过程。具体目标3的重点是开发新的基于模拟的培训 急诊医师学习和实践特定认知策略的模块。这些模块将 这样，他们就可以与现有的培训计划相结合。在本研究结束时， 我们将为急诊医生制定一套认知策略，以减轻 急诊室的干扰。这项工作还将作为后续建议的基础， 评估培训的有效性和有效性，并使干预措施适用于其他领域， 医护人员，如护士。

Project Summary/Abstract The nature of the Emergency Department is such that emergency physicians are frequently interrupted as they perform their duties; emergency physicians have been described as "interruption driven". While many of these interruptions are necessary for the emergency department to function effectively, they can also disrupt emergency physician performance resulting in a very serious patient safety risk. Interrupting emergency physicians leads to an increase in error rates, information loss and the amount of time taken to deliver care. Our innovative approach to mitigate the disruptiveness of interruptions is to develop specific cognitive strategies for emergency physicians to employ when interrupted. Cognitive strategies are deliberate actions that the physician can take during an interruption, which will facilitate the resumption process. To develop the strategies, we leverage a theory from the human factors literature that accounts for the cognitive mechanisms underlying task interruption and resumption. By combining this theory, our prior work, and observational data from the emergency department, a set of trainable cognitive strategies that are tailored to the workflow and needs of the physician will be developed. In Specific Aim 1, we will observe emergency physicians at three different hospitals and document the types of interruptions they encounter as well as the contextual variables surrounding the interruptions. These data will be analyzed for a quantitative understanding of the factors associated with emergency physician interruptions. Specific Aim 2 will utilize the findings from Specific Aim 1 to adapt and develop specific cognitive strategies that are tailored to the needs of emergency physicians. The descriptions of each cognitive strategy will detail the conditions in which each strategy should be applied and process for applying each strategy. The focus of Specific Aim 3 is developing new simulation-based training modules for emergency physicians to learn and practice the specific cognitive strategies. These modules will be developed such that they can be integrated with existing training programs. At the conclusion of this study we will have developed a set of cognitive strategies for emergency physicians to mitigate the disruptiveness of interruptions in the emergency department. This work will also serve as the basis for a follow-on proposal to evaluate the validity and effectiveness of the training and to adapt the intervention to other domains and healthcare workers such as nurses.