Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation.
Introduction: Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that e...
| Publicado en: | Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Vol. 20; no. 1; pp. 177 - 185 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
Jan2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133740973&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133740973 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1936900X 8B61 jtl: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health issn: 1936900X maglogo: N pubinfo: dt: Jan2019 vid: 20 iid: 1 pid: 29816 pub: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health place: Orange, California artinfo: ui: 133740973 133740973 133740973 10.5811/westjem.2018.10.39962 133740973 ppf: 177 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation. aug: au: Soares III, William E. Price, Lori L. Prast, Brendan Tarbox, Elizabeth Mader, Timothy J. Blanchard, Rebecca affil: University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts. sug: subj: Task Performance and Analysis Treatment Errors ST Segment Myocardial Infarction Diagnosis Electrocardiography Human Simulations T-Tests Odds Ratio Confidence Intervals Workflow ab: Introduction: Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that emergency physicians (EP) frequently encounter. To address interruptions such as ECG interpretation, many EPs engage in task switching, pausing their primary task to address an interrupting task. The impact of task switching on clinical errors in interpreting screening ECGs for STEMI remains unknown. Methods: Resident and attending EPs were invited to participate in a crossover simulation trial. Physicians first completed a task-switching simulation in which they viewed patient presentations interrupted by clinical tasks, including screening ECGs requiring immediate interpretation before resuming the patient presentation. Participants then completed an uninterrupted simulation in which patient presentations and clinical tasks were completed sequentially without interruption. The primary outcome was accuracy of ECG interpretation for STEMI during task switching and uninterrupted simulations. Results: Thirty-five participants completed the study. We found no significant difference in accuracy of ECG interpretation for STEMI (task switching 0.89, uninterrupted 0.91, paired t-test p=0.21). Attending physician status (odds ratio [OR] [2.56], confidence interval [CI] [1.66-3.94], p<0.01) and inferior STEMI (OR [0.08], CI [0.04-0.14], p<0.01) were associated with increased and decreased odds of correct interpretation, respectively. Low self-reported confidence in interpretation was associated with decreased odds of correct interpretation in the task-switching simulation, but not in the uninterrupted simulation (interaction p=0.02). Conclusion: In our simulation, task switching was not associated with overall accuracy of ECG interpretation for STEMI. However, odds of correct interpretation decreased with inferior STEMI ECGs and when participants self-reported low confidence when interrupted. Our study highlights opportunities to improve through focused ECG training, as well as self-identification of “high-risk” screening ECGs prone to error during interrupted clinical workflow. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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