Clinical Report: Is This Visit Interrupting Something More Important?

Overview

The article describes how expanding communication channels and competing tasks interrupt outpatient visits, affecting clinician attention, patient experience, and staff workload. It cites evidence linking interruptions with increased cognitive load, reduced efficiency, and clinical errors, while noting a lack of comparable US outpatient interruption research from the past decade.

Background

Interruptions have long been part of clinical practice, but electronic health records and multiple asynchronous communication platforms have increased the number of channels clinicians must monitor. The article reports that outpatient internal medicine physicians in China experienced 6.46 interruptions per hour; it states that comparable US outpatient investigations have not been conducted during the past decade. Interruptions can affect task performance and the quality of clinician–patient interactions, while staff may have to make communication decisions without standardized guidance. The article frames these pressures as a system-design issue affecting clinicians, patients, and frontline staff.

Data Highlights

Key Findings

• Outpatient clinicians manage communication across patient portals, secure staff messaging, fax, and mail, with distinct interfaces and expectations for response.
• The article cites research indicating that interruptions impair task performance and, in physicians, increase cognitive load, diminish efficiency, and contribute to clinical errors.
• Patients may experience fragmented attention during visits; the article notes that increased physician eye contact has been associated with greater patient-perceived trust.
• Medical assistants and other staff act as communication gatekeepers and may lack standardized guidance on when to interrupt clinicians or which communication modality to use.
• The article links unclear staff communication expectations with stress, increased error risk, job dissatisfaction, and burnout; it also notes that remote work since the COVID-19 pandemic has limited face-to-face access to colleagues.
• The US ONC SAFER Guide: Clinician Communication identifies full EHR inboxes as a hazard that can lead to overlooked critical information and describes structured communication practices, including escalation of unread messages to alternate coverage.

Clinical Implications

The article presents interruptions as a system-level concern rather than an individual failure and calls for approaches that address communication workflows across clinicians, patients, and staff. The ONC SAFER Guide advises structured practices for monitoring and routing electronic communications, including escalation of unread messages to alternate coverage.

Conclusion

The article describes how fragmented communication can disrupt outpatient encounters and place competing demands on clinicians and staff. It identifies system-level workflow design and reliable communication practices as relevant areas for addressing these pressures.

Related Resources & Content

1. US Office of the National Coordinator for Health Information Technology, SAFER Guide: Clinician Communication, 2025 -- SAFER: Clinician Communication
2. The Joint Commission, 2025 -- Patient Safety Systems (PS)
3. World Health Organization, 2025 -- Goal 2: Enhance medication safety
4. ASCO Publications — The impact of interruptions on physician workflow, productivity, and delivery of care.
5. ASCO Publications — Follow-up calls after emergency department and in-patient encounters: Are we making a difference?
6. ASCO Publications — Completion time in prostate cancer treated with proton beam therapy: Do interruptions matter?
7. ASCO Publications — Completion time in prostate cancer treated with proton beam therapy: Do interruptions matter?
8. SAFER: Clinician Communication
9. Patient Safety Systems (PS)
10. Goal 2: Enhance medication safety
11. National Patient Safety Goals®
12. National Patient Safety Goals (NPSGs) | Joint Commission
13. The effect of interruptions on prescribing accuracy with relevance to advanced practice: an integrative review of the research literature - The UWS Academic Portal
14. Effectiveness of Interventions for Reducing Interruptions During Medication Administration: A Systematic Review - Zhang - 2025 - Worldviews on Evidence-Based Nursing - Wiley Online Library
15. Trends in Patient Portal Messages, Office Visits, and Telephone Encounters | Digital Health | JAMA | JAMA Network
16. Trends in Physician Electronic Health Record Time and Message Volume | Coronavirus (COVID-19) | JAMA Internal Medicine | JAMA Network
17. The Inbox Problem: Standardized Protocols for Primary Care Teams to Address Patient Messages.
18. Primary care staff members’ experiences with managing electronic health record inbox messages - PMC
19. Clinicians’ PTO Undermined by Patient Portal Work, Study Finds | Professional Well-being | JAMA | JAMA Network