Communication loads on clinical staff in the emergency department

Objective: To measure communication loads on clinical staff in an acute clinical setting, and to describe the pattern of informal and formal communication events. Design: Observational study. Setting. Two emergency departments, one rural and one urban, in New South Wales hospitals, between June and July 1999. Participants: Twelve clinical staff members, comprising six nurses and six doctors. Main outcome measures. Time involved in communication; number of communication events, interruptions, and overlapping communications; choice of communication channel; purpose of communication. Results: 35 hours and 13 minutes were observed, and 1286 distinct communication events were identified, representing 36.5 events per person per hour (95% Cl, 34.5-38.5). A third of communication events (30.6%) were classified as interruptions, giving a rate of 11.15 interruptions per hour for all subjects; 10% of communication time involved two or more concurrent conversations; and 12.7% of all events involved formal information sources such as patients' medical records. Face-to-face conversation accounted for 82%. While medical staff asked for information slightly less frequently than nursing staff (25.4% v 30.9%), they received information much less frequently (6.6% v 16.2%). Conclusion: Our results support the need for communication training in emergency departments and other similar workplaces. The combination of interruptions and multiple concurrent tasks may produce clinical errors by disrupting memory processes. About 90% of the information transactions observed involved interpersonal exchanges rather than interaction with formal information sources. This may put a low upper limit on the potential for improving information processes by introducing electronic medical records.