It is well documented that interruptions during consultations are upsetting to both doctors and patients. About 10% of GP consultations are interrupted for one reason or another. When surveyed, patients felt that over 50% of these interruptions were unnecessary, and 20% felt that the interruption had a negative impact on the consultation.
Nurse consultations are interrupted more, with up to 50% of nurse consultations being interrupted in one study. However, the patient impact is less when nurses are interrupted,
The commonest form of interruption for a GP is by the telephone, followed by someone coming to the door. For practice nurses, the commonest form of interruption is by the GP coming into the room.
The effect of interruptions is not only on the patient’s perception, but also has a negative impact upon the quality of the outcome of the consultation. A recent trial showed that when a consultation is interrupted, nearly 20% of the outcomes from the consultation are missed, for instance; medical notes not completed effectively, prescription errors, or referrals being forgotten.
Interruptions during the consultation are clearly having a negative impact on performance. There is also evidence that interruptions between consultations can also have a negative impact, with similar errors occurring, especially prescriptions errors and forgotten actions from the previous consultation.
It is, therefore, important to reduce the number and frequency of interruptions. Here are some suggestions to help with this-
Have a practice protocol about interruptions, stating when they are important and when they are not.
Have only one person per day who is “interruptible” e.g. a duty clinician.
Have set times during the day when other work can be completed, such as; answering queries, signing prescriptions, making telephone calls. Make these times protected and make sure both staff and patients know when these times are, so that the clinician does not have to deal with these things at other times.
Only interrupt a consultation for a clinical emergency.
If an interruption between consultations is unavoidable, make sure that the clinician being interrupted has finished the previous clinical encounter completely before the new issue is introduced. This will avoid items from the previous encounter being missed.