Funding for this conference was made possible (in part) by 1R13HS020139-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. This issue of Academic Emergency Medicine is funded by the Robert Wood Johnson Foundation.
Learning from Accident and Error: Avoiding the Hazards of Workload, Stress, and Routine Interruptions in the Emergency Department
Version of Record online: 13 DEC 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Special Issue: Proceedings of the 2011 AEM Consenus Conference: Interventions to Assure Quality in the Crowded Emergency Department Guest Editors: James R. Miner, MD Manish N. Shah, MD, MPH
Volume 18, Issue 12, pages 1246–1254, December 2011
How to Cite
Bradley Morrison, J. and Rudolph, J. W. (2011), Learning from Accident and Error: Avoiding the Hazards of Workload, Stress, and Routine Interruptions in the Emergency Department. Academic Emergency Medicine, 18: 1246–1254. doi: 10.1111/j.1553-2712.2011.01231.x
The authors have no potential conflicts of interest to disclose.
Supervising Editor: James Miner, MD.
- Issue online: 13 DEC 2011
- Version of Record online: 13 DEC 2011
- Received July 19, 2011; revision received August 19, 2011; accepted August 20, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:1246–1254 © 2011 by the Society for Academic Emergency Medicine
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.