New research showed that interruptions drastically increase a nurse's mental workload during EMR documentation.
Every workplace comes with its distractions, but most don’t carry stakes quite as high as an emergency department (ED). And for nurses in the ED, interruptions during electronic medical record (EMR) documentation are worse for their workflow than during any other task.
That finding came from a group of University of Missouri researchers. Jung Hyup Kim travelled with his students up to the Mayo Clinic in Rochester, Minnesota to spend a week observing how the ED nurses there worked.
They broke the nursing workflow into 8 main tasks: direct patient care, indirect patient care (like reviewing test results or setting up a room), EMR documentation, communication with colleagues, travelling between destinations, work outside the ED, social moments like meals and breaks, and other tasks. The most common interruptions were from phone calls, colleagues, residents, doctors, or patient family members.
During their time at Mayo Clinic, they followed experienced nurses and timed their way through these behaviors. Kim’s team then used a Goals/Operators/Methods/Selections rules simulation model to see how interruptions added to the nurses’ mental workload during those tasks.
“Based on our analysis, we figured out if ED (emergency department) nurses were interrupted in patient care activities, their workload was about two times higher,” Kim explained. “With EMR documentation…the workload was about four times higher than in a non-interruption scenario.” That's important, because a more intense mental workload correlates with a higher chance of errors. And when it comes to patient care, or even the act of documenting it, those errors can compromise safety and raise costs.
Kim, an assistant professor Industrial and Manufacturing Systems Engineering, has devoted plenty of time to studying how to make nursing more efficient. The new research follows a previous report which explored how nurse movement throughout an intensive care unit using wearable trackers.
He said nurses should probably be trained to avoid non-emergency phone calls and queries while providing patient care or using the EMR systems. Relatives of patients should probably take note, too, not to interrupt the nurses.
The work doesn’t point the finger at the EMRs themselves—though medical professionals often do. The systems themselves are frequently berated for being confusing and time-consuming to use—and overall, healthcare workers have increasingly called for a less-crowded, more straightforward digital environment.
Mayo Clinic has previously used a combination of GE and Cerner platforms across its different departments and locations, but is currently in the midst of a systemwide Epic rollout.