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Interruptions are frequent in many work domains. Researchers in health care have started to study interruptions extensively, but their studies usually do not use a theoretically guided approach. Conversely, researchers conducting theoretically rich laboratory studies on interruptions have not usually investigated how effectively their findings account for humans working in complex systems such as intensive care units. In the current study, we use the memory for goals theory and prospective memory theory to investigate which properties of an interruption influence how long it takes nurses to resume interrupted critical care tasks. We collected data with a mobile eye tracker in an intensive care unit and developed multiple regression models to predict resumption times. In 55.8% of all interruptions there was a finite-and therefore analyzable-resumption lag. For these cases, the main regression model explained 30.9% (adjusted R 2 ) of the variance. Longer interruptions (␤ ϭ .36, p Ͻ .001) and changes in physical location due to interruptions (␤ ϭ .40, p Ͻ .001) lengthened the resumption lag. We also calculated regression models on subsets of the data to investigate the generality of the above findings across different situations. In a further 37.6% of all interruptions, nurses used behavioral strategies that greatly diminished or eliminated individual prospective memory demands caused by interruptions, resulting in no analyzable resumption lag. We introduce a descriptive model that accounts for how nurses' behaviors affect the cognitive demand of resuming an interrupted task. Finally, we discuss how the disruptive effects of interruptions in the intensive care unit could be diminished or prevented.Keywords: interruptions, prospective memory, memory for goals, distributed cognition, intensive careIn the present study, we use theoretical models of interruptions and prospective memory to investigate factors that might make it easier or harder for people to return to an interrupted task. The potentially disruptive effects of interruptions on cognition are well recognized. Interruptions have been examined in aviation (e.g., Dismukes, Young, & Sumwalt, 1998), driving (e.g., Strayer & Johnston, 2001), human-computer interaction (e.g., Iqbal & Horvitz, 2007;McFarlane, 2002), and health care (e.g., Chisholm, Collison, Nelson, & Cordell, 2000;Coiera & Tombs, 1998;Parker & Coiera, 2000). In safety-critical domains, interruptions might contribute to errors and accidents. For example, Westbrook, Woods, Rob, Dunsmuir, and Day (2010b) showed that interruptions increase the chance of medication administration errors.Although studies have investigated interruptions in applied settings, most studies are descriptive. In contrast, in the present study we have aimed for a theoretically motivated causal account. To our knowledge, in health care only one empirical paper on interruptions appears to have used a theoretically motivated approach (for reviews see Biron, Loiselle, & Lavoie-Tremblay, 2009;. In a retrospective analysis of findi...

Interruptions occur frequently in the operating room with both positive and negative consequences. Interruptions can distract anesthesiologists from safety-critical tasks, such as the pretransfusion blood check. In a simulated operating room, 12 anesthesiologists requested blood as part of a "bleeding patient" scenario. They were distracted while their assistant accepted delivery of the product and began transfusing without performing the standard check. Anesthesiologists who immediately engaged with the interruption failed to notice the omission, whereas those who rejected or deferred the interruption all noted and remedied the omitted check (P < 0.05). We discuss the role of displays and strategies on safety.

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Objective: To highlight the importance of the personal experience of users who interact with technology in safety-critical domains and summarize three interaction concepts and the associated theories that provide the means for addressing user experience. Background: In health care, the dominant concepts of interaction are based on theories arising from classic cognitive psychology. These concepts focus mainly on safety and efficiency, with too little consideration being given to user experience. Method: Users in complex socio-technical and safety-critical domains such as health care interact with many technological devices. Enhancing the user experience could improve the design of technology, enhance the well-being of staff, and contribute to modern safety management. We summarize concepts of “interaction” based on modern theories of human–computer interaction, which include the personal experience of users as an important construct. Results and Conclusion: Activity theory, embodiment, and interaction as experience provide a theoretical foundation for considering user experience in safety-critical domains. Using an example from anesthesiology, we demonstrate how each theory provides a unique but complementary view on experience. Finally, the methodological possibilities for considering personal experience in design and evaluations vary among the theories. Application: Considering user experience in health care and potentially other safety-critical domains can provide an additional means of optimizing interaction with technology, contributing to the well-being of staff, and improving safety.

Providing a subset of studied items as retrieval cues can have detrimental effects on recall of the remaining items. In 2 experiments, the authors examined such part-list cuing impairment in a repeated testing situation. Participants studied exemplars from several semantic categories and were given 2 successive cued-recall tests separated by a distractor task of several minutes. Part-list cues were provided in the 1st test but not the 2nd. Noncue item recall was tested with the studied category cues (same probes) in the 1st test, but novel, unstudied retrieval cues (independent probes) in the 2nd test. The authors found detrimental effects of part-list cues in both the 1st (same-probe) test and the 2nd (independent-probe) test. These results show that part-list cuing impairment can be lasting and is not eliminated with independent probes. The findings support the view that the impairment was caused by retrieval inhibition.

Sleep deprivation reduces cognitive performance; however, its effects on prospective memory (remembering to perform intended actions) are unknown. One view suggests that effects of sleep deprivation are limited to tasks associated with prefrontal functioning. An alternative view suggests a global, unspecific effect on human cognition, which should affect a variety of cognitive tasks. We investigated the impact of sleep deprivation (25 hours of sleep deprivation vs. no sleep deprivation) on prospective-memory performance in more resource-demanding and less resource-demanding prospective-memory tasks. Performance was lower after sleep deprivation and with a more resource-demanding prospective-memory task, but these factors did not interact. These results support the view that sleep deprivation affects cognition more globally and demonstrate that sleep deprivation increases failures to carry out intended actions, which may have severe consequences in safety-critical situations.

Summary Tracheal intubation requires the anaesthetist to adopt an awkward body posture. To investigate how posture may be improved, we compared the effects of laryngoscopy technique (GlideScope® vs Macintosh blade) and experience (novices vs experts) on body posture angles and the Rapid Entire Body Assessment postural analysis score. Novices (25 medical students) and experts (26 anaesthetists) were video‐recorded performing intubation in a manikin using both devices. The GlideScope resulted in smaller deflections for all analysed posture angles (all p values < 0.001) except the wrist compared with the Macintosh blade. Novices showed more trunk (p < 0.001) and neck (p = 0.002) flexion than experts. Using the GlideScope resulted in a lower Rapid Entire Body Assessment score compared with using the Macintosh blade (p < 0.001), indicating that the GlideScope resulted in body posture less likely to induce musculoskeletal injuries. From an ergonomic point of view, the GlideScope should be the preferred technique for laryngoscopy.