Background: Interruptions of hospital doctors' workflow are a frequent stressor, eventually jeopardising quality of clinical performance. To enhance the safety of hospital doctors' work, it is necessary to analyse frequency and circumstances of workflow interruptions. Aim: To quantify workflow interruptions among hospital doctors, identify frequent sources and relate sources to doctors' concurrent activities. Methods: Within a typical hospital, 32 participant observations of doctors' full work shifts were carried out. Timeemotion information was collected on types of workflow interruption and doctors' activities and analysed with logitelinear analyses. Results: The frequency of workflow interruptions was high, especially on the intensive care unit and emergency ward. Telephones and bleepers were the most frequently recorded type of work interruption. The combined analysis of doctors' activities and concurrent workflow interruptions revealed that the likelihood of the occurrence of certain types of interruption depended on the tasks being carried out by the doctor. Conclusion: The present method may be useful for quantifying and distinguishing sources of hospital doctors' workflow interruptions and useful in raising awareness of organisational circumstances.

Background: Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact -a key principle of effective medical care. Second, simultaneous task performance ('multitasking') which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested.