The impact of interruptions on physician workflow, productivity, and delivery of care.

Abstract

201 Background: Physician interruptions during clinic and non-clinic hours can lead to medical errors, provider fatigue, prolonged clinic times, reduced academic output and poor job satisfaction. Repetitive interruptions can hamper the ability of physicians to deliver high quality patient-centered care. This study aims to evaluate the type, frequency, duration and self-reported physician response interruptions physicians experience in clinic. Methods: A work observation study was conducted at the Odette Cancer Centre, Sunnybrook Health Sciences Centre in Toronto, Canada. In-clinic data were collected from September 22 to October 6, 2016 using time-motion analyses by shadowing multiple oncologists in clinic. Interruption data were collected and categorized as follows: type of interruption, length of interruption, reason for interruption and role of interrupter. Physicians were asked to record and track themselves regarding interruptions they experienced during non-clinic hours using the same criteria. Results: Over a 2-week period, 5 medical oncology clinics (median 4 hours (hrs) per clinic), were observed and tracked. The clinic physicians averaged 22 interruptions per block, equating to 6 interruptions/hr (one interruption every 10 minutes (mins)). Over the 5 sessions, 112 data points were collected totaling over 1 hr 48 mins of interrupted time. Interruptions averaged 80 seconds (range of 4 to 517) in length with a positive skewed distribution. This calculates to approximately 30 mins of cumulative interrupted time per clinic session. Most interruptions were under 4 mins in length (4.1 at 95 th percentile). The type of interruption varied but was most commonly in-person (67), email (24) and text message (10). Conclusions: Interruptions account for approximately 30 mins of physician time during a 4-hour clinic. An assessment of the type and frequency of requests proved highly variable, creating inconsistent ways messages are delivered to physicians. Interruptions potentially impact on patient care and disrupt the workflow of the clinic. These data provide future directions for exploring efficient clinic workflows and establishing standardized means of communicating with physicians during clinic hours.

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