Considerable attention has been focused on limiting interruptions to physicians during patient encounters. No one seems concerned, however, about interrupting inpatient nurses.
A physician’s clinical workflow is very similar to a nurse caring for hospitalized patients. They both go room to room, managing many patients throughout the day while offering individualized attention to one patient at a time.
So, why is it okay to interrupt an inpatient nurse every few minutes and it's not okay to interrupt a physician?
One could strongly argue that hospitalized patients need even more focused and individualized attention from their caregivers and deserve uninterrupted nursing care. Frequent interruptions in patient rooms can lead to loss of focus, poor patient care and patient dissatisfaction. Ringing or vibrating phones that must be answered, or wearable speaker devices that require an immediate response from a nurse, lead to interruptions that produce inefficiency and frustration.
A 2010 study published in the Archives of Internal Medicine was the first to show a clear association between nurse interruptions and medication errors. Each interruption, the study found, was associated with a 12.7 percent increase in clinical errors. And, according to the Institute for Safe Medication Practices, nurses administering medications are distracted and interrupted as often as once every two minutes. Among the key culprits: excessive alerts from phones, overhead pages, voice alerts and alarms.
Similar to ambulatory physicians, inpatient nurses must have asynchronous communication methods that do not interrupt patient care for routine requests but can alert a nurse when an urgent situation arises. If inpatient nurses are given phones that ring (synchronous communication) or technology that speaks, interruptions are frequent and patient care is compromised.
What Nurses Need:
- Inpatient nurses are smart and they deserve a smartphone—either through a BYOD policy or provided hardware.
- On the smart phone they deserve clinical communication software that provides asynchronous secure communication that does not interrupt them for non-urgent requests or for messages that could be replied to at a more opportune time.
- They should have at their fingertips the ability to contact all physicians caring for patients, along with access to schedules that tell them whom to contact and when.
- They should be protected from alert fatigue and not be interrupted with alarms unless it’s an urgent situation.
The Ideal Workflow Scenario:
- Patient alarms and calls should be triaged through the desk clerk.
- The desk clerk can send routine messages to nurses, which can be answered after pressing patient responsibilities are met.
- Desk clerks can also message nurse assistants who can handle non-urgent requests from patients.
- Urgent messages can be identified and answered immediately.
This workflow enables inpatient nurses to have uninterrupted time with their acute-care patients, which allows them to maintain focus, provide higher quality care and generate higher patient satisfaction.
Jose Barreau, MD, CEO of Doc Halo, is a Hematologist/Oncologist and former physician executive director of the TriHealth Cancer Institute.