My suspicion is that the ED is the most intense place to work in the hospital. You could probably even substitute “stressful” for “intense”.
I will never prove this and I’m not trying to pull a “woe is us” type moan about how we work much harder than everyone else. The hardest I have ever worked is in the ED, no doubt about it, but this is of course personal anecdote and I’m really not trying to get one up on someone else.
But I do find the way and manner and context in which we work in the ED to be of particular interest.
Take these two studies:
Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”? Acad Emerg Med 2000 Nov.;7(11):1239–1243. PMID 11073472
Coiera EW, Jayasuriya RA, Hardy J, Bannan A, Thorpe MEC. Communication loads on clinical staff in the emergency department. Med. J. Aust. 2002 May;176(9):415–418. PMID 12056992
Basically they followed docs and nurses about the ED and watched what they did and how often they were interrupted and what the interruptions were. These were classified and defined as interruptions not just phone calls and doing different things in the order they were meant to be done.
They both found roughly the same answer. 10 interruptions per hour. Or every 6 minutes if you like.
My anecdotal experience is that it’s probably higher than that, certainly in the UK system with its relative staffing shortages compared to either the US or australasia.
Two thirds of these interruptions led to the doc stopping what they were doing and attending to the new thing.
It is bloody annoying being interrupted every few minutes. Just listen to the juniors on the ward complaining about their pagers going off.
But it is the only way to work. Especially in the ED – all kinds of shit is going off all around you (Though hopefully not this…) and your job is to respond appropriately no matter how annoying it might be.
People who are good at this tend to make good emergency docs. People who are smarter go and do anaesthetics… (in jest honestly…)
I went from doing 5 days a week to 4 days a week when I was 28. I’m now 30 and if I get out of my tweed sweater, patches on sleeves lecturing I’ll try and only go back at 3 or 4 days a week.
ED work is brilliant but boy it’s intense.
Enrico Coeira (one of the main authors on most of the research on this) left a comment below that’s worth checking out along with some additional papers to check out that I’ve reposted here:
Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study. BMJ 1998 Feb.;316(7132):673–676. PMCID 9522794
Westbrook JI, Coiera E, Dunsmuir WTM, Brown BM, Kelk N, Paoloni R, Tran C. The impact of interruptions on clinical task completion. Qual Saf Health Care 2010 Aug.;19(4):284–289. PMID 20463369
Spencer R, Coiera E, Logan P. Variation in communication loads on clinical staff in the emergency department. Ann Emerg Med 2004 Sep.;44(3):268–273. PMID 15332070
Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010 Apr.;170(8):683–690. PMID 20421552 (free)