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I go to place an order.

NOPE.

Stop.

POP UP alert.

…Read alert.

…Click selection.

Type out my reasoning which is required.

Click okay.

…Uh Oh.

I forgot what I was ordering.

Frustration.

Fear.

What was it that the patient needed?

Think for a few moments. Never remember.

Sigh and move on.

Next time?

POP UP.

Ignore alert.

Make random selection.

Type in jibberish to make it go away so I don’t forget my order.

…

That is alarm fatigue.

Not only is the alert now useless because I’m ignoring it (for good reason), but you can see in the first situation it caused a medical error.

Does the IT department or CMIO assume the risk of that medical error?

Nope. Just the bedside doctor.

That was a response to one of my posts on Twitter. I agree.

While I could absolutely go full-on keyboard warrior on IT departments and CMIOs… I won’t do that today (but look out for posts coming soon).

We can’t control everything. But there are some things we can control. More on that later.

But first, what’s the problem?

Context Switching

We don’t multitask. We just switch from one task to the other rapidly. But it’s not that easy.

As Addy Osmani describes context switching:

Anyone in medicine knows that distractions are ubiquitous. It’s practically impossible to get into deep work. So, what do people that are constantly distracted do?

Per this study:

Sound familiar? Yeah. Burnout.

Are doctors better at context switching? Nope. We’re human.

This study showed that even a distraction of 3 seconds doubled participant’s chances of making a mistake.

THREE seconds.

DOUBLED the chances of a mistake.

That’s terrifying.

Look at this graphic:

I’d consider what we do a “professional activity that requires a lot of brain power.” And if I was a patient, I’d want my doctor’s brain on the right of the graph rather than the left.

The reality is we’re all definitely 100% without-a-doubt, full-on in the deep end of the left side without so much of a whiff of the right side.

How to stop context switching?

We work in hospitals and urgent things happen. We can’t stop those.

But, can we limit those non-urgent distractions which are the vast majority? Yes.

Move to text-based communications

First, if not already, implore your hospital to switch to HIPAA compliant text-based communications (like EPIC’s secure chat) rather than phone calls. This allows you to save texts for later and prioritize work. Your hospital system should have an escalation process for urgent and emergent notifications. Again, if not, implore them to to do so.

Some despise the increasing use of text-based communications, but I love them because it allows me to prioritize my tasks. With phone calls? I have no idea if it’s urgent or not. I HAVE to answer at THAT moment.

Then, ruthlessly time-block.

What is time-blocking?

It’s a time-management technique where you divide your day into blocks of time each dedicated to a specific task. It allows that “deep work” mindset.

Before I settle into one of my deep work time-blocks, I check my secure chats, respond to any messages and clear my inbox.

I have 3 dedicated deep work time blocks set each day:

• Pre-rounding

• Writing orders and discharges

• Writing notes

So, my daily routine looks something like this:

Of course, an admission may happen at any moment and throw off this schedule.

Also, I may have smaller time blocks throughout this schedule. For example, I try to enter into a deep-work period during admissions while I’m putting in orders and writing my H&P.

Set boundaries

Once you have your time blocks, set boundaries during that time.

Close the door if you can. Heck, put up a sign. Do whatever you have to.

If you work in an office full of co-workers, like I do, then have some way to let them know you’re focusing. I’ll often tell my cubicle neighbor, “Okay I’m going into the matrix” and put my earphones in. He knows not to talk to me during that period.

Don’t sabotage yourself

Don’t work in busy areas like the nursing station or the doctor’s lounge. You’re setting yourself up for distractions.

Background conversations can catch your attention. Use noise-cancelling headphones to drown those out.

Turn off non-hospital notifications on your phone. Don’t check social media.

Reward yourself

I will have small breaks built into some of my time-blocks.

While writing notes I may make an effort to write 6 notes. After the 6th note, I take a small break.

This allows me to avoid the temptation of checking my phone during my deep-work. I will “reward” myself after completing my task.

For any IT departments and CMIO’s reading this:

Reducing distractions should be your first priority. Yes, I said it. First. Let’s rein it in, people.

Don’t create pop ups that occur when we first open the chart or when we’re about to put in orders. How about customizing them? Let people choose when they want non-urgent pop ups. Not possible? Time to talk to the EMRs (Epic? Are you listening?) Or what about after we sign our note? Have end-users (aka bedside providers) involved in every intervention you create.

Anyway…

Time-blocking helps me limit distractions and provide better error-free patient care. Hopefully it helps you too.

To ER docs out there: I don’t know how you do it. I have the utmost respect for you all.

That’s all for now.

Please feel free to reach out and ask questions as they help inspire future issues!

Cheers,

Robert

When you’re ready, there are two ways I can help you:

Check out The Practical Guide to Attending Documentation.

• CME approved for 3.5 hours! Use your CME funds!

• Bill confidently (and reduce down codes) and know what’s ACTUALLY needed for billing.

• Spend less time writing notes

• Use notes to PREVENT lawsuits

Check out The Resident Guide to Clinical Documentation. The course that helps you:

• Impress your attendings and improve your evaluations.

• Prepare for real-world productivity pressures

• Gain the confidence to write shorter yet more effective notes.

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