Develop interruption guidelines about appropriate interruptions and educate staff about the harms of unnecessary interruptions.

Assign tasks that cause frequent interruptions (e.g., transfers/lab follow-up) to one team member per shift and realign other tasks so that the assigned team member can focus on only those tasks.

Case study:

• Sturdy Memorial Hospital

Additional resources:

• Triage ECG intervention (Rebel EM)

Set certain off-limit times/zones for clinicians during critical times, such as medication prescribing and administration, sign-off and discharge to enable more reliable execution of these critical tasks.

Case study:

• St. Anne’s Hospital

Tools like an electronic whiteboard or secure text applications allow clinicians to check messages when they have the opportunity rather than breaking their task.

Case study:

• Sturdy Memorial Hospital

Medical scribes assist with documentation, reducing the amount of time physicians must spend at the EHR and increasing time for direct patient care. Emergency departments may use scribes to document, perform order entry, admit/discharge, request consults, pull-up prior patient data, and alert providers to new/ important information.

Case study:

• UMass Memorial Health Care

The pharmacy team may assist with medication selection and safety, care of critically ill patients, antimicrobial stewardship, and calculation of weight-based dosing. Studies show that having a pharmacist on-staff in the ED may reduce medication errors by two-thirds.

Use pharmacy technicians to complete medication histories and medication reconciliation. This has been shown to both increase accuracy of medication histories and reduce medication errors by as much as half.

Use paramedics within the ED to complete tasks such as triage, starting IVs, and offloading patients from arriving Emergency Medical Services units.

Case study:

• Lowell General Hospital

Identify and implement key clinical pathways that are up-to-date and readily accessible to clinicians to help guide triage and treatment of patients.

Case study:

• UMass Memorial Health Care

Use kits or carts for select procedures to reduce the need for hunting and fetching of materials and equipment, enabling providers to stay focused on performing the procedure.

Case study:

• Baystate Medical Center
• Lowell General Hospital

Implement checklists for use during procedures that are high-risk but infrequently performed to reduce the risk of complications.

Case study:

• Boston Children's Hospital

Additional resources:

• An Intubation Checklist for Emergency Department Physicians (ACEP Now)

Adopt only clinically validated EHR reminders to prevent interruptions that are clinically meaningless and poorly targeted.

Consult with clinical end-users of EHR systems during development and implementation of EHR systems

Case study:

• Beth Israel Lahey Health

Establish an EHR governance structure to consult with clinical end-users, monitor use of alerts and complete a periodic reassessment to ensure that they are clinically appropriate and relevant.

Case study:

• Beth Israel Lahey Health
• Beth Israel Deaconess Clinical Informatics Committee Charter

Use huddles at key times to ensure communication of important information.

Case studies:

• Baystate Medical Center
• Cambridge Health Alliance

Additional resources:

• Course module: Implementing a daily team huddle (American Medical Association)
• Video: Safety Huddles in the ED (MedStar Health)

Make sure team members are aware of each others' identified roles/ responsibilities and experience level.

Additional resources:

• Betsy Lehman Center Clinician and Staff Peer Support Program

Use hospital wellness resources to provide specific support to ED clinical teams.

Case study:

• Berkshire Health Systems

Additional resources:

• Being Well in Emergency Medicine: ACEP’s Guide to Investing in Yourself
• MHA’s Caring for the Caregiver

Clinical teams need scheduled time for meals, restroom breaks and lactation.

Additional resources:

• Eating and Drinking in Work Stations is Permissible (ACEP)
• Eating and Drinking in the Emergency Department: What you need to know (ACEP)