Paediatric resident workflow observations in a community-based hospital

BMJ Open Quality

article

Jennifer R Di Rocco¹  Chieko Kimata³  Masihullah Barat⁴  Samantha Kodama² 

[1] Pediatrics , Kapi’olani Medical Center for Women and Children;Pediatrics , University of Hawai’i at Mānoa John A Burns School of Medicine;Patient Safety & Quality Services , Hawai’i Pacific Health;University of Hawai’i at Mānoa John A Burns School of Medicine

关键词: interruptions;    paediatrics;    graduate medical education;   

DOI  :  10.1136/bmjoq-2021-001607

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Objective Residency graduates need to demonstrate competence in prioritising safe patient care through appropriate management of multiple competing tasks and workflow interruptions. This pilot study aimed to characterise and correlate interruptions in paediatric resident workflow at an academically affiliated, community-based hospital.Methods One of three trained observers followed a resident physician during a convenience sample of 1–2 hour increments, either in the emergency department or on the wards, and recorded all observed activities and interruptions using an established time-motion tool. All participants completed a baseline Multi-Tasking Ability Test (MTAT) and pre-observation and post-observation surveys. Statistical approach included descriptive statistics, logistic regression, mixed model and ORs.Results 18 paediatric residents were observed for 57.5 total hours (an average of 3.2 hours/resident) which included 329 interruptions, defined as any external event drawing the resident’s attention away from a primary task. Interruptions occurred an average of 5.9 times per resident per hour. Interrupted primary tasks were not resumed during the observation period 11% of the time. A personal/social-related interruption yielded an OR of 0.29 that the resident will return to a primary task within 5 min (p=0.007) when compared with patient-related verbal interruptions by the medical team. The MTAT Score indicated decreased efficiency for interns versus postgraduate year 2 residents (p=0.029). Residents’ MTAT Scores did not correlate with their time to return to a primary task following an interruption (p=0.11).Conclusions Paediatric resident workflow interruptions in the hospital were observed to occur frequently and should be expected. Personal/social interruptions were most likely to delay prompt return to a primary task. The MTAT Score, although improved between the first 2 years of residency training, did not correlate with efficient return to a primary task. Interruption management and mitigation strategies should be developed as part of a standardised residency task management curriculum.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND