Mitigating Interruptions in the ED

Kim Johnson has 14 years of experience as an emergency department (ED) and trauma nurse. Now an assistant professor and PhD program director at the College of Nursing, she says one of the most frustrating aspects about being a nurse is how often interruptions occur. “It’s one thing to be interrupted if it’s something important, but if it’s a frivolous interruption that interferes with something important you’re doing, it’s incredibly frustrating,” says Johnson, PhD, who in fall 2018 received a research grant from the Agency for Healthcare Research and Quality to investigate effective strategies to prevent and mitigate the impact of interruptions for ED nurses.

Kim Johnson, PhDDr. Johnson defines an interruption as “anything that interferes with the activities a nurse is doing.” When a patient enters an ED, the first health care provider he or she interacts with is typically a nurse during the initial triage interview. That’s when a nurse asks about his or her symptoms and then determines the patient’s acuity level, or how quickly the patient needs to be seen. An interruption happens when a patient’s family member, a physician, coworker, or another nurse interrupts the triage process, causing the triage nurse to pause and decide how to respond to the interruption before continuing the triage process.

Interruptions happen throughout the hospital, Dr. Johnson says, but they’re especially prevalent in the ED. “That’s how the emergency department functions. It’s very interruption-driven,” she says. “My research focuses specifically on the triage process. Because that’s the first time nurses have contact with patients, it’s imperative we get that right.” It’s especially imperative, Dr. Johnson says, because interruptions during the triage process can lead to medication errors and even fatal adverse events. Her research also shows that triage times are 40% longer when interruptions occur.

“My research focuses specifically on the triage process. Because that’s the first time nurses have contact with patients, it’s imperative we get that right.”

—Kim Johnson, PhD, Assistant Professor & PhD Program Director

Dr. Johnson began researching the impact interruptions have on ED nurses in 2011, when she pursued a post-doctoral fellowship with the VA Quality Scholars program in Cleveland. Her work, which involved improving processes for ED nurses, revealed that interruptions are common among nurses, but often, they aren’t trained on managing them. “We all recognize that interruptions are a problem, but no one ever talks about how you manage them,” Dr. Johnson says. “When you ask other nurses, ‘How did you learn how to deal with interruptions?’ they say, ‘Experience. You just learn. You make mistakes and you learn.’ But that’s not good enough. We need to be more proactive and address interruptions before they happen so we’re not learning on the fly and have a game plan on how to deal with them when they happen.”

The “game plan” Dr. Johnson aims to create for ED nurses using her research grant includes an educational intervention, or training module, to prepare triage nurses for effective interruption management. The research grant comprises a two-year study with two specific aims: identify strategies used by triage nurses to effectively manage interruptions, and develop and pilot test an educational intervention to improve triage nurses’ interruption-management skills. The study’s long-term goals include improving the quality of patient care, safety and outcomes. In May, Dr. Johnson and her team completed the first phase of determining successful strategies, with help from an online modified Delphi panel of nine triage and operational management experts. The second phase of developing and testing the educational intervention is still underway, but Dr. Johnson expects it will conclude by next fall, when the research grant expires. “[The educational intervention] will include a short discussion/presentation, then new triage nurses will practice the strategies they discussed in the simulation lab using standardized patients to triage,” Dr. Johnson says. She plans to use the study’s findings to apply for a research grant from the National Institutes of Health to evaluate the effectiveness of the educational intervention.

Although Dr. Johnson no longer practices in the ED, she’s still invested in the experiences of current ED nurses in her role as president of the Ohio Emergency Nurses Association. This research study is only one way she continues improving processes in the ED. “Even though I’m not at the bedside right now, I’m still passionate and involved with emergency department nursing, because this is where I can do the most good for the nursing profession right now,” she says. “If I can use my training and expertise to help the emergency nurses who are currently working ‘in the trenches’ to provide better care for patients, I’m happy with my contribution to improving the quality of care for patients.”

By: Katie Coburn

Topics: magazine