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- Title
Learning from Accident and Error: Avoiding the Hazards of Workload, Stress, and Routine Interruptions in the Emergency Department.
- Authors
Bradley Morrison, J.; Rudolph, Jenny W.
- Abstract
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.
- Publication
Academic Emergency Medicine, 2011, Vol 18, Issue 12, p1246
- ISSN
1069-6563
- Publication type
Academic Journal
- DOI
10.1111/j.1553-2712.2011.01231.x