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Doc APProvED

The Most Solvable Cause of Medical Error

Mohseni, Alex MD

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doi: 10.1097/01.EEM.0000482478.66450.a4

    I usually share apps and websites that make emergency medicine practice easier, but this month I'm proposing a product that should exist, that could solve a common cause of medical error and EP frustration and burnout.

    That application is none other than an ED chat application — a tool through which physicians, nurses, techs, radiology, and lab could communicate nonemergent information in an organized fashion without interrupting each other (i.e., asynchronously). Because such a tool doesn't exist and the small comments section in most EMR tracker boards is woefully inadequate, all communication in the ED requires one party to interrupt the other party, regardless of the reason or importance of the disruption.

    The insanity of this might not at first be obvious. The studies that exist on interruptions in the ED and their causal role in medical error are unanimous in their condemnation: Emergency physicians are interrupted on average 10 times per hour, though it certainly feels like 10 times per minute. Each interruption results in an increased risk of a medical error (up to 12 percent per interruption in one study). Compound this with the fact that most ED communication is actually not emergent.

    Every other industry has evolved to solve this issue by building tools and systems to minimize interruptions. We have yet to solve this challenge despite the relative importance of our work compared with these other industries. Many workplaces use group chat applications such as Slack or HipChat to streamline communications, and I would proffer that a similar solution customized for the ED (modified so that discussions revolve around patients instead of projects) would be revolutionary in reducing unnecessary interruptions.

    Imagine for a moment that instead of calling the lab to follow up on missing lab work, you could send a notification to the lab about the missing test, and then the lab could respond to you and the appropriate nurse that the sample was never received. The nurse could then send you a message that the patient doesn't have IV access, and she needs you to put in a line — all communicated without interruptions. That, my friends, is the dream, and would go a long way in reducing medical errors and physician burnout.

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