Citation

Morrison JB, Rudolph JW. Acad. Emerg. Med. 2011; 18(12): 1246-1254.

Affiliation

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.

Copyright

(Copyright © 2011, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/j.1553-2712.2011.01231.x

PMID

22168187

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.

Language: en