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6 Strategies for the Organized Mind

Posted on Mon, Apr 10, 2017
6 Strategies for the Organized Mind

Healthcare professionals have mastered the art of multi-tasking. But, the skill that has long been valued is now seen as a liability, especially with the new and increased focus on high-quality, error-free care. This was the premise of a keynote address titled, “The Organized Mind and Information Overload,” that Daniel Levitin, Ph.D., recently delivered. Dr. Levitin is a James McGill Professor of psychology, behavioral neuroscience and music at McGill University in Montreal. He is also the author of several books including the No. 1 best-seller, “The Organized Mind: Thinking Straight in the Age of Information Overload.”

Dr. Levitin told attendees that information overload often causes mistakes and that it can lead to deadly consequences in the hospital. Taking a cue from other industries that have pioneered efforts in safety and high reliability, such as aviation and heavy machinery, researchers are now studying the causes and effects of interruptions and distractions in the clinic.

It is easy to understand the potential impact interruptions have on patient safety. A 2005 study conducted by Alvarez and Correra of a hospital intensive care unit (ICU) identified 838 interruptions in 24 hours for an attending staff of nine physicians. The study identified two types of interruptions – turn-taking interruptions (where the person speaking is interrupted by the person he or she is speaking to) and breaking into a conversation interruptions (a third person interrupts a conversation that is occurring between two people). People tend to interrupt because they feel they need to know something immediately.

A 2010 study of ICU nurses by Anthony identified 75 interruptions during medication preparation in an eight-hour shift. Recognizing the potential for medication errors, the hospital placed red tape around the central medication area and the medication prep cart, designating the space as a “no interruption zone.” Medication errors fell by 50 percent as a result of this proactive intervention.

Dr. Levitin led the audience through six major themes that appear to be getting worse in the hospital setting. First, he discussed the Myth of Multi-Tasking. “The brain simply doesn’t work that way,” he explained. “When presented with a task, a project file opens in the cortex. As additional tasks or interruptions occur, new project files are opened. As the brain shifts from one thing to another, you are not fully engaged in any one thing. You deplete your neuro resources every time you switch because switching releases cortisol that causes interference in a variety of ways – increased heart rate, elevated blood pressure and disrupted digestive system. All of these can contribute to foggy thinking, sort of like being drunk, but you aren’t aware of it.”

“Uni-taskers” get more done, are more creative and produce higher quality work output than multi-taskers,” Dr. Levitin said. Other industries recognize this phenomenon and have instituted policies to mitigate it. For example, pilots cannot have unnecessary conversations below 10,000 feet. This rule enables them to focus solely on critical conversations with one another and with air traffic control. Air traffic controllers are required to take a break after working two hours. Likewise, to stay fresh and focused, translators at the United Nations cannot work more than 90 minutes consecutively.

The second theme was the Importance of Naps and Breaks. Dr. Levitin said we don’t fully understand why a 15-minute break if done correctly, can hit the “neuro reset” button in the brain. He cited research that identified the default mode network comprised of the central executive mode and daydreaming or mind-wandering mode. The central executive mode keeps you on-task and fully focused so that everything goes right. There is a distinct set of neuro circuits that are involved in this state. When you are in the daydreaming or mind-wandering mode, your thoughts are loosely connected from one moment to the next. This is the mode of the brain in which spent glucose is restored. It is also the most creative mode and one that enables us to think and solve problems. People do many things to enter this mode such as listening to music, immersing themselves in nature or going for a walk. In this mode, your mind wanders non-linearly making connections between things that normally don’t go together and, as a result, making solutions more apparent. Snacking during the day is also beneficial in restoring glucose. Dr. Levitin encouraged attendees to incorporate 10 to 15 minutes of mind-wandering a day while working in the Emergency Department (E.D.).
Decision Fatigue was the third major theme. Researchers have recently discovered a network of neurons that help people make decisions. The network does not distinguish between important and unimportant decisions. This information is valuable because it can help us govern the ways we schedule our brain power and make decisions during the day. He cited an example of judges, who in a recent study, were shown to make better decisions just after beginning work in the morning or right after lunch. The quality of their decision making declines as time passes between meals. So, if you’re innocent, you want a court case early in the morning or just after lunch. If you’re guilty, you want your case heard late in the afternoon. “Your mother was right,” Dr. Levitin said. “If you have an important decision to make, sleep on it and make it the next day.” He acknowledged that everyone has to make dozens of decisions each day. “But, you have the luxury to know that some decisions will be better than others, depending on the time of day. In some cases, it may be best to consult another colleague who is fresher regarding decisions that have to be made.”
The fourth major theme he highlighted was Externalizing Your Memory. “Writing things down reduces the burden of having to remember them,” he explained. “We tend to think our memories are better than they are. Memory is fallible, so it’s best to put things out in the world, so they don’t have to stay in your brain.” David Allen, an efficiency guru, says writing things down on note cards is a mind-clearing exercise. Studies have shown that people who write things down remember them better than those that type them. Use the environment to remind you of things you need to do. Set up a system to remind you where you put things – keys, wallet and/or telephone. Put a bowl by the door to provide a consistent location to place these items. If you check into a hotel room, experts recommend spreading a white hand towel out on a nightstand to designate a place to put your room key, wallet, phone, etc. Dr. Levitin described transactional memory systems as shared information structures. “People who are most effective and have the most power in organizations aren’t necessarily ones who know everything, but they do know the people to call to get the information. These people are extensions of memory because they help the other person keep track of all of the information.”

Managing Channels of Communication was the fifth major theme. “In this era of connectivity, we must figure out ways to manage how people reach us,” he said. “We have to train people in our social networks about how we want to be reached and when. There are truly a limited number of people who need to reach us immediately. Using a second email address for urgent communication is one way to manage contact. The worst thing to do first thing in the morning is to open up email. Every email requires us to make a decision. Before you’ve really done anything meaningful, you’ve already depleted your decision-making capacity.”
Dr. Levitin wrapped up his presentation with the sixth major theme – Ways to Handle Information Overload Better. “This really is the age of information overload,” he told the audience. “Every day of last year, Americans took in five times as much information as they did in all of 1986. That’s the equivalent of reading 175 newspapers cover to cover daily. In fact, we have created more information in the last four years than in all of human history before. Specialization has created a glut of information. Consider that last year 2,000 papers were published on the visual system of the squid. For every hour of YouTube video you watch, there are 12,000 additional hours of video being uploaded.”

How severe is the problem of overload and how does it exacerbate the number of decisions we have to make? In 1976, the average grocery store stocked 9,000 unique items. Today, more than 40,000 unique items populate grocery store shelves. Why is this important? Decision making has a neurobiological cost associated with it.
Bringing the topic back to the E.D., Dr. Levitin advised attendees to have a serious conversation about collaboration and record keeping. “We can talk faster than we can write,” he said. “Remember when physicians used the Dictaphone to capture their notes? Now we all have this capability on our smartphones. That’s why there has been an explosion of voice to data conversion programs. Developers are currently perfecting automated data entry into the patient record. No interruption zones are a great idea, as are mandatory short breaks that allow for mind wandering. Checklists provide an important avenue for externalizing memory. Examples include surgical checklists, palliative care checklists, medication administration checklists, etc. They reduce the stress of multi-tasking. Finally, I urge you to consider implanting gatekeepers – human or mechanical – to take extraneous calls and messages that create interruptions. These gatekeepers will protect your time and will help put into priority what will come into your sphere of decision making.”


Nurses: Take Time to Care for Yourself

Posted on Thu, Oct 15, 2015
Nurses: Take Time to Care for Yourself

This year, the Emergency Nurses Association (ENA) is celebrating Emergency Nurses Week from Oct. 11 to Oct. 17. Emergency Nurses Day is Wednesday, Oct. 14. In a year when Ebola and the measles made international headlines, this year’s theme is “Celebrating the Courage of Nurses Worldwide,” recognizing that emergency nurses courageously stand at the front line of emergency care every day. Be sure to thank an emergency nurse today – and every day.
By Ginger Wirth, RN
I recently had the pleasure of being on a call that discussed provider burnout – from nurses to doctors to advanced practice providers and anyone else who “provides” care for patients and their families. The speaker, Dan Smith, MD, Studer Group® coach, national speaker, and practicing emergency department physician, talked about the importance of taking care of ourselves, which really resonated with me.
The delivery of healthcare is frequently a juggling act. As providers, we have to balance the clinical care we provide with the compassionate care we share, balanced with our internal beliefs and past experiences. At times these may be in conflict, but those truly dedicated to caring for the patients push much of that aside and do all they believe is right at the time to deliver the best possible care and outcomes for the ones we are caring for.
Clinicians have the “clinical” piece “down to a science” and are able to postulate a care plan or diagnosis easily, as most of us are “unconsciously skilled” when it comes to the medicine. It can frequently be the emotional side of caring for patients or even their families that throw us for a loop. Those in emergency medicine can attest that those feelings frequently get pushed to the side while we are in the thick of it and often are forgotten and never truly dealt with. We need to do better and take better care of ourselves.
3 Ways to Take Better Care of Yourself
Three areas where we can make a significant improvement in how we deal with these everyday stressors and take care of ourselves are fairly easy:
1. Sleep is Crucial - There are studies that show that those who are routinely sleep deprived, meaning getting less than 6 hours of sleep at night can have these physical effects:

  • Heart disease: Cardiovascular disease is the No. 1 killer in the United States. And to think that sleep deprivation plays some part in it boggles the mind.
  • Anger: Research has shown a correlation between hostility and increased sleep disturbance. So don't blow your stack; sleep on it instead!
  • Fatigue: Consider this—well over 100,000 car accidents in North America occur every year due to sleep deprivation. More than 6,000 fatalities. Sad, tragic, and unnecessary
  • Weight gain: Research shows a link between lack of sleep, weight gain, and obesity. Napping to lose weight? That works for me!
  • Anxiety: Recent research suggests that sleep deprivation can cause anxiety, fear and worry.
  • Blood sugar: Researchers have discovered a connection between sleep deprivation and diabetes, in particular, type 2 diabetes.
  • High blood pressure: Studies have shown that people who sleep less than six hours a night have a significantly higher risk for high blood pressure.
  • Illness: Infections and weaker immune system
  • Frustration with life: Perhaps this is why alcohol and drug abuse are signs of sleep deprivation.
  • Irritability
  • Memory issues, including reduced cognitive function, decreased mental sharpness, lack of focus and drive
  • Blurred vision
  • Increased pain
  • Shortened life expectancy
  • Inflammation (a factor in numerous diseases, including certain types of cancer) 

2. Exercise is so Important!
  • The American Heart Association recommends 30 minutes of moderate exercise a day, five days a week, 75 minutes of vigorous exercise a week.
    • Use some of the latest tools: Pedometers/trackers like Fitbit, Apple watch, Jawbone, Ped, Omron or Garmin. Most have apps that you can share with friends and challenge each other, which make the experience much more fun.
  • Decreases anxiety and stress
  • Helps control your weight
  • Reduces your risk of cardiovascular disease
  • Reduces your risk for type 2 diabetes and metabolic syndrome
  • Reduces your risk of some cancers
  • Strengthens your bones and muscles
  • Improves your mental health and mood
  • Improves your ability to do daily activities and prevent falls, if you're an older adult
  • Increases your chances of living longer 

3. Healthy eating - Remember we get out what we put in!
  • There is a balance to eating. Most days, eat from each food group: grains, protein, vegetables and fruits, and dairy. Listen to your body. Eat when you're hungry. Stop when you feel satisfied.
  • Variety is the spice of life (literally). Be adventurous. Choose different foods in each food group. Pick a recipe from that cookbook you bought on sale. You might find a new favorite. Eating a variety of foods each day will help you get all the nutrients you need. Use different spices to vary the taste of even your favorite foods.
  • Everything in moderation! We say that for most things in life, and food is no different. Don't choose too much or too little of one thing. All foods, if eaten in moderation, can be part of healthy eating. Even sweets can be okay. 

One of the most important takeaways from this is BALANCE. As healthcare professionals, it’s just as important that we balance our own lives and health just like we balance the care we provide each and every day. We deliver better care when we feel better ourselves. We make the difference in the lives we touch with every encounter, every day! Let’s give them and ourselves our very best! Next steps from here: Take a walk, eat a carrot and then take a good long nap!

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.