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Learning from Accident and Error: Avoiding the Hazards of Workload, Stress, and Routine Interruptions in the Emergency Department
Author(s) -
Bradley Morrison J.,
Rudolph Jenny W.
Publication year - 2011
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2011.01231.x
Subject(s) - workload , emergency department , medicine , virtuous circle and vicious circle , crowding , resilience (materials science) , reliability (semiconductor) , medical emergency , nursing , management , psychology , cognitive psychology , power (physics) , physics , quantum mechanics , economics , macroeconomics , thermodynamics
ACADEMIC EMERGENCY MEDICINE 2011; 18:1246–1254 © 2011 by the Society for Academic Emergency Medicine Abstract This article presents a model of how a build‐up of interruptions can shift the dynamics of the emergency department (ED) from an adaptive, self‐regulating system into a fragile, crisis‐prone one. Drawing on case studies of organizational disasters and insights from the theory of high‐reliability organizations, the authors use computer simulations to show how the accumulation of small interruptions could have disproportionately large effects in the ED. In the face of a mounting workload created by interruptions, EDs, like other organizational systems, have tipping points, thresholds beyond which a vicious cycle can lead rather quickly to the collapse of normal operating routines and in the extreme to a crisis of organizational paralysis. The authors discuss some possible implications for emergency medicine, emphasizing the potential threat from routine, non‐novel demands on EDs and raising the concern that EDs are operating closer to the precipitous edge of crisis as ED crowding exacerbates the problem.