Providers in the emergency department deal with interruptions on a more frequent basis than other specialties. Interruptions addressed in the poll occur when providers need to divert attention to respond to staff or patient requests, interpret ECGs, answer phone consults, listen to EMS communications, and a variety of other tasks. A study by Chisholm et al found that emergency physicians were interrupted 9.7 times an hour, compared to 3.9 times an hour for primary care physicians.⁸ Other studies have shown that emergency practitioners average about 10 interruptions an hour.^1,9 These interruptions will ultimately reduce the efficiency and produce stress for clinicians.⁶ Despite emergency providers’ skills in multitasking, interruptions reduce efficiency and open the door to errors in documentation and order placement.

There are additional elements that cause unneeded stress in the work environment. The workstation is the site of work performed for an estimated 44 percent of the shift, and with the introduction of mandatory clinical information systems, the computers are the operational cockpit for the physician and APP.⁷

 Provider-Focused Workstation Design

A critical first step to improve the provider environment is ergonomic and functional workstation design. Ideally, a provider workstation would be located near the nurses’ station, but not at a location that results in frequent interruptions. The current state is with a flexible height chair or stool, bare walls, and drop ceilings with non-absorptive materials, making audio privacy almost impossible. Reference materials are taped or pinned to the walls, and a phone is somewhere, but without a fitted headpiece.

The actual “desks” or counter space are not conducive to good work or even good health. Some emergency departments don’t even have dedicated desks for physicians.

Optimally, there should be dedicated workstations appropriate for the number of providers who are working at the busiest times. The workstations would have user-flexible features from counter to desk height and computer screens and keyboards adjustable to ergonomic positions.

Seating options should include flexible height and comfortable stools for seating. Ergonomic seating must support clinician joints in a natural and neutral position. Both the chair and desk should be adjustable to a height and position of optimal comfort. DeRango et al noted that ergonomic chairs improved productivity, in addition to reducing pain scores.¹⁰

The workstation needs a set of wall-mounted computer screens that provide the clinician with a view of the tracking board; the radiologic imaging system; system status of the ED, hospital, and EMS; and any necessary external feeds (risk management, reference materials, weather, news briefs, old ECG’s, telehealth, and special events). Many of these could be on shared screens for all providers in that work area. However, each provider needs a dedicated work computer for patient management.