Work-related stress and interruptions in the emergency department

The impact of interruptions in the workplace has begun to receive a lot of attention in the last few years (Mark, Klocke, 2008). Different studies have shown that interruptions can result in lapses of attention, memory or perception increasing cognitive load, stress and anxiety, deteriorating decision-making performance, but data are not always convergent (Hudson et al., 2002). In particular, in healthcare only limited evidence (Ebright et al., 2003) has been available. This study investigated the impact of interruption of physician stress in an emergency care department of an Italian Hospital. A total amount of 180 h of observation were performed. Observed physicians were evaluated for cognitive level of stress before and after the observed work shift. Visual analogical measures and a Self-Perceived Stress scale were used. We also evaluated personality dimensions using the BIS/BAS scale (Carver and Whyte, 1994). BIS reflects a reaction towards events that occurred (like interruptions), and hence a sensitivity to these events. We found that doctors were typically interrupted 7.1 times per hour; 18% percent of all tasks were interrupted. Consistent with the literature, the sources of interruptions most often were other physicians (23%), and fixed telephone (21%). In 84% of the interruptions, physicians returned to the interrupted activity; in 16% they did not. Interruptions led emergency department doctors to spend less time on the tasks they were working on. Furthermore, a signi ficant correlation between the number of interruption and the level of stress variation was found. We also found that doctors with higher scores at the BIS scale actually showed higher level of work related stress, but we didn't' find a correlation with the number of interruptions experienced. The study suggests that interrupted physicians often experience a higher workload, more stress, more time pressure, leading people to change not only work regularity but also mental and physiological states. The e ffect of this change might be mediated by some biological and personality dimensions. Our data may be a starting point to improve the emergency department sterilization by interruptions helping physician to reduce cognitive workload and stress and thus limiting the potentials effect on adverse events.