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CAUSES
AND
OCCURRENCES OF INTERRUPTIONS
DURING ED TRIAGE
Authors: Kimberly D. Johnson, PhD, RN, CEN, Michele Motavalli, MBA, BSN, RN, CCRN, CEN,
Dean Gray, MBA, and Connie Kuehn, RN, Cincinatti and Cleveland, OH
provision of conveniences to visitors, coworker-related interruptions, patient carerelated interruptions, locating of family
members in the emergency department, and other miscellaneous
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TABLE 1
Number of occurrences, daily means, and standard deviations for all categories and subcategories of interruptions
Category
Subcategory
Total
Mean
SD
Opening door
For staff
For family
Other
Total for category
Asking persons to stand
backprivacy
Phone
Directions
Appointment information
Changing television channel
Requesting forms
Calling cab
Weight/blood pressure checks
Food/water
Other
Total for category
Perform electrocardiograms
Registration folders to rack
Take patient back to
emergency department
Other
Total for category
Veteran drivers asking for
disposition of veteran
Locate family member
Direct admissions issues
Coworker (nonpatient
carerelated interruption)
Total for category
77
69
12
158
22
7.7
6.9
1.2
15.8
2.2
5.2079
1.969207
1.813529
6.65332
3.155243
5
20
17
1
2
0
13
24
29
133
21
10
23
0.5
2
1.7
0.1
0.2
0
1.3
2.4
2.9
13.3
2.1
1
2.3
0.971825
1.333333
2.057507
0.316228
0.421637
0
1.567021
1.837873
2.601282
5.711587
3.107339
2.211083
4.347413
23
77
6
2.3
7.7
0.6
1.888562
7.06242
1.074968
22
4
17
2.2
0.4
1.7
2.529822
0.699206
3.267687
49
71
4.9
7.1
5.520211
8.089087
Provision of
conveniences to visitors
Other
Patients asking
How much longer?
Total for all categories
436
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120
100
80
60
40
20
0
Mon
Tues
Wed
Thurs
Tues
Wed
Thurs
Fri
Mon
Tue
FIGURE 1
Total interruptions per shift.
Results
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Discussion
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Nunber of Interruptions
180
160
140
120
100
80
60
40
20
0
Opening Door
Convenience to
visitor
Patient care
related
Asking "How
much longer"
other
Categories
FIGURE 2
Cause of triage interruptions.
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The main limitation of this study was that the triage nurses
were responsible for recording when interruptions occurred.
Therefore it is possible that some interruptions were missed,
and the act of documenting the interruption may very well
have constituted an interruption.
Other limitations are the small number of days when
data were collected and the collection of data at a single
institution during a single shift. Although our data showed
common and consistent categories of interruptions, we do
not know whether these categories hold true for weekends,
for off-shifts, or at other facilities.
Next steps
interruptions were investigated (ie, operating room, postanesthesia care units, and inpatient medication administration), links have been made that have shown patient care to be
adversely affected. There is sparse information on how
interruptions in triage affect patients or staff. When one
considers the fact that ED triage is the entry into the health
care system, this is especially surprising. With the limited
information available on the causes and implications of
interruptions in ED triage, more research needs to be
conducted to explore this phenomenon. The relatively
unexplored area of triage interruptions needs further investigation to ensure patient safety and privacy and to ensure that
optimal care is being provided for emergency patients.
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Conclusion
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