Traditions of research into interruptions in healthcare: A conceptual review

McCurdie, Tara; Sanderson, Penelope; Aitken, Leanne M.

doi:10.1016/j.ijnurstu.2016.11.005

Cited by 31 publications

(34 citation statements)

References 138 publications

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“…In addition, the literature reflects different, and often isolated, viewpoints of researchers from different backgrounds who have different biases and beliefs that affect their research questions. McCurdie et al (2017) demonstrate this, by showing that the impact of interruptions is studied as a function of task time and risk by epidemiologists, in relation to situation awareness by cognitive systems engineers, and with a focus on resumption lag by cognitive psychologists. This wide range of dependent variables contributes to the complexity of the literature.…”

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confidence: 94%

Interruptions and Delivery of Care in the Intensive Care Unit

et al. 2019

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This study samples interruption frequency in intensive care unit (ICU) settings to assess the relationship between interruptions and common patient hazards. Background: Task interruptions are accident contributors in numerous industries. Recently, studies on health care interruptions and their impact on patient hazards have received attention. Method: Seven ICUs in four hospitals participated in a 24-month study. Experienced ICU nurses directly observed nursing tasks, interruptions, and patient hazards (delays in care, breaks in device task protocols, and patient safety hazards). Results: During 1,148 hours of observation, 175 nurses performed 74,733 nursing tasks. Interruptions occurred at a rate of 4.95 per hour, and 8.4% of tasks were interrupted. Interruptions originated mostly from humans (65.9%), alarms (24.1%), and others (10%). A total of 774 patient hazards were observed, with a hazard occurring on average every 89 minutes. Relative to noninterrupted tasks, device alarm interrupted nonstructured tasks were associated with increased rates of delays in care and safety hazards (rate ratio [RR] = 3.19). In contrast, rate of delays in care and safety hazards did not increase during human interrupted tasks (RR = 1.13). Rates of protocol nonadherence varied by device type and were highest during artificial airway, medication administration, chest tube, and supplemental oxygen management. Conclusion: Interruptions in the ICU are frequent and contribute to patient hazards, especially when caused by device alarms during nonstructured tasks. Nonadherence to protocols is common and contributed to patient hazards. Application: The findings suggest a need for improvement in task and device design to reduce patient hazards.

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confidence: 94%

Interruptions and Delivery of Care in the Intensive Care Unit

et al. 2019

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“…Instead of avoiding interruptions universally, the resilience of work systems to adverse effects from interruptions should be strengthened by allowing purposeful interruptions that promote professional collaboration, patient satisfaction and safe care 10 35. Our findings advocate for further investigations on the profession-specific effects of interruptions, including sources, contents and type of interrupted activity, with particular attention to role-related sequelae of provider functioning, patient safety, and efficiency of ED care 10. However, although positive effects of interruptions are postulated, research in this domain should be conducted in light of striving for well-balanced work and care systems that promote safe patient care and well-designed work environments for providers.…”

Section: Discussionmentioning

confidence: 76%

Provider interruptions and patient perceptions of care: an observational study in the emergency department

2018

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BackgroundInterruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly understood. We aimed to distinguish beneficial and detrimental forms of interruptions of emergency department (ED) providers using patients’ perceptions of ED care as a quality measure.MethodsAn observational design was established. The study setting was an interdisciplinary ED of an academic tertiary referral hospital. Frequencies of interruption sources and contents were identified in systematic expert observations of ED physicians and nurses. Concurrently, patients rated overall quality of care, ED organisation, patient information and waiting times using a standardised survey. Associations were assessed with hierarchical linear models controlling for daily ED workload. Regression results were adjusted for multiple testing. Additionally, analyses were computed for ED physicians and nurses, separately.ResultsOn 40 days, 160 expert observation sessions were conducted. 1418 patients were surveyed. Frequent interruptions initiated by patients were associated with higher overall quality of care and ED organisation. Interruptions relating to coordination activities were associated with improved ratings of ED waiting times. However, interruptions containing information on previous cases were associated with inferior ratings of ED organisation. Specifically for nurses, overall interruptions were associated with superior patient reports of waiting time.ConclusionsProvider interruptions were differentially associated with patient perceptions of care. Whereas coordination-related and patient-initiated interruptions were beneficial to patient-perceived efficiency of ED operations, interruptions due to case-irrelevant communication were related to inferior patient ratings of ED organisation. The design of resilient healthcare systems requires a thorough consideration of beneficial and harmful effects of interruptions on providers’ workflows and patient safety.

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“…Interruptions that seem to be associated with MAEs include lost time, staff and patient frustration, and cognitive failures (Dismukes, ; Elfering, Grebner, & Ebener, ; McCurdie, Sanderson, & Aitken, ). While there are many studies explored the frequency and its underlying reasons attributing to interruptions by the observation method, few studies examined the frequency and courses of interruptions in pediatric units (Özkan et al, ).…”

Section: Introductionmentioning

confidence: 99%

Interruptions experienced by nurses during pediatric medication administration in China: An observational study

Jun-wen

Qiaoling

Wang

et al. 2019

Specialist Pediatric Nursing

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Purpose The objectives of this study were to describe (a) the frequency of interruptions experienced by a pediatric nurse per hour, (b) the sources of interruptions experienced by a pediatric nurse, and (c) the interruption outcomes during pediatric medication administration. Design and Methods This design of this study was a cross‐sectional observational study. A convenience sample of pediatric nurses was used in this study. The interruption observation sheet was used to collect data about the frequency, sources, and outcomes of interruptions. Results There was a total of 43 nurses were observed in more than 180 medication administration rounds. An interruption rate of 94.51% occurred during pediatric medication administration. The frequency of interruptions was three or more times (51.04%). The most common source of interruption was attributed to the working environment (32.37%). The second most frequent reason for interruption came from personnel, such as caregivers (24.48%), followed by physicians (10.79%), and other nursing staff (9.54%). The third most common source of interruption was communication issues, including patient interviews, patient reports, and case discussion (8.71%). Six errors (2.49%) were reported out of 241 interruptions as a result of interruptions. In specific, causes of errors during pediatric medication administration were due to wrong medication dose. Practice Implications This study provides important information on interruptions experienced by pediatric nurses during medication administration in Chinese hospital settings and found that interruptions frequently occur in pediatric units.

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Traditions of research into interruptions in healthcare: A conceptual review

Cited by 31 publications

References 138 publications

Interruptions and Delivery of Care in the Intensive Care Unit

Interruptions and Delivery of Care in the Intensive Care Unit

Provider interruptions and patient perceptions of care: an observational study in the emergency department

Interruptions experienced by nurses during pediatric medication administration in China: An observational study

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