The emergency department receives and processes patients at an unpredictable volume and arrival pattern. The patients present with a range of illnesses and injuries. There may be significant time constraints to evaluate and disposition patients. High-risk procedures are performed at unplanned times. There is a need to constantly adjust and adapt to a changing clinical environment.
There are variable patterns of support staffing in the emergency department and with the hospital medical staff that can disrupt a provider’s actions and thought processes.1 These interruptions can translate to medical errors and adverse events, which can lead to unwanted stress and inefficiencies for the provider.2-6 In addition to this, the implementation of computerized physician order entry requires the physician to interact with a computer at an estimated burden of 4,000 keystrokes per 10-hour shift.7
Workstations for physicians and advanced practice providers (APPs), to date, have not been tailored to the increasingly digitized workspace, nor to the providers’ needs. The physician and APP workspace should consider comfort and efficiency, with a primary design objective to improve quality and patient safety. A secondary outcome is likely to be a positive effect on provider satisfaction.
Various medical specialties already accomplish this. Radiologists have the appropriate lighting, dictation system, and computer screens to do their job correctly. In the operating room, all equipment is prepped in advance for surgeons to execute their work.
The authors did a convenience polling of several hundred emergency medicine providers at a leadership symposium. Emergency physicians and APP’s were asked which aspect of the clinical work environment would benefit the most from redesign. About 300 EM providers were given the following options: a comfortable and efficient workspace, decreasing the number of interruptions, a private/quiet retreat for documentation and personal use, or having meals and snacks available.
Survey results found the number one improvement providers would like to see in their on-shift clinical environment was a comfortable and efficient workspace, with 41 percent of the votes. The second most commonly selected, 35 percent of responses polled, was to decrease the amount of interruptions. Lower preferences were to have meals/snacks available, followed by a private space for work and personal use, with 16 percent and 8 percent of responses, respectively.
Further polling proposed the question of what EM providers felt was most helpful to decrease interruptions during their shifts. Options included: a desktop messenger system to communicate with all staff, a HIPAA-compliant cell phone app for texting, a physical indicator at the workstation to signal when a provider is busy, or portable computers for bedside use. The top answer was a desktop messenger system (39 percent), followed by a cell phone app (32 percent). A lower percentage of providers opted for the workstation indicator signal and bedside computer (16 percent and 12 percent, respectively).