It’s fitting that I’ve been interrupted many times while I’ve been writing this column. My topic is interruptions in the work of a hospitalist. I’ll leave it to you to judge whether the interruptions I suffered while writing have adversely affected the quality of this column. The more important question is how much the quality, efficiency and patient safety of hospitalists’ work suffers because of interruptions.
For the most part, the hospital where I worked as an orderly (how is that for an antiquated term!) in the 1970s was like a library; nursing stations usually were quiet and slow paced, well suited for concentration and focus. Today, the nursing station in a typical hospital looks more like the floor of the stock exchange, with many people trying to talk over each other and jostling for a position at a computer. People who study this kind of thing would say that we increasingly work in high-tempo settings with a high communication burden, and, as a result, our work has become increasingly “interrupt driven.”
It is tempting to say hospitalists (and emergency room doctors and others) have to do a lot of multitasking. But I think that we’re really “switch tasking” most of the time, rather than multitasking.1 Switch tasking means frequently changing tasks. With some regularity we stop in the middle of one task and switch our attention to another—and incur two costs in the process. One cost is the mental energy consumed and stress of frequently shifting our attention.
The other cost is that it is reasonably common that we fail to return to the original task, so it remains uncompleted. How often have you promised a patient you’d write a PRN order for a sleeping pill, but got interrupted and never circled back to write the order? And it is easy for most of us to think of similar errors with more significant consequences.
Kevin O’Leary and colleagues at Northwestern University in Evanston, Ill., conducted a time-motion study of hospitalists. It found hospitalists were interrupted by pages an average of 3.4 times per hour (+/- 1.5).2 Emergency room (ER) doctors face an environment similar to hospitalists, and one study found ER doctors were interrupted an average of once every 5 minutes, and two-thirds of the time did not return to the prior task.3
Interruptions vs. Sleep Depravation
I’ve found it difficult to adjust my work style and habits to keep up with the pace of change and the increasing frequency of interruptions. My first, and generally ineffective, impulse is to try and decrease the noise and interruptions by doing things like asking others to page me less often, and only for time-sensitive clinical issues and not for routine things. But the problem is that promptly addressing many of these interruptions is our job, not simply a distraction.
Even if we can’t make the interruptions go away, we can try to manage them. In 2005, I was thrilled to learn of an emerging field known as “interruption science.” For a really engaging look at this field, search the Internet for “Meet the Life Hackers,” an article by Clive Owen in the New York Times [Sunday] Magazine, October 16, 2005. It describes people who are devoting their research careers to understanding the best ways to manage interruptions and where our attention shifts next.