| Learning from accident and error: avoiding the hazards of workload, stress, and routine interruptions in the emergency department. | |
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MedLine Citation:
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PMID: 22168187 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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J Bradley Morrison; Jenny W Rudolph |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 18 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 1246-54 Citation Subset: IM |
Copyright Information:
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© 2011 by the Society for Academic Emergency Medicine. |
Affiliation:
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From the Brandeis International Business School (JBM), Waltham, MA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; Department of Anaesthesia, Harvard Medical School; and Center for Medical Simulation (JWR), Cambridge, MA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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