Objective To understand the complex effects of interruption in healthcare. Materials and methods As interruptions have been well studied in other domains, the authors undertook a systematic review of experimental studies in psychology and humanecomputer interaction to identify the task types and variables influencing interruption effects. Results 63 studies were identified from 812 articles retrieved by systematic searches. On the basis of interruption profiles for generic tasks, it was found that clinical tasks can be distinguished into three broad types: procedural, problem-solving, and decision-making. Twelve experimental variables that influence interruption effects were identified. Of these, six are the most important, based on the number of studies and because of their centrality to interruption effects, including working memory load, interruption position, similarity, modality, handling strategies, and practice effect. The variables are explained by three main theoretical frameworks: the activation-based goal memory model, prospective memory, and multiple resource theory. Discussion This review provides a useful starting point for a more comprehensive examination of interruptions potentially leading to an improved understanding about the impact of this phenomenon on patient safety and task efficiency. The authors provide some recommendations to counter interruption effects. Conclusion The effects of interruption are the outcome of a complex set of variables and should not be considered as uniformly predictable or bad. The task types, variables, and theories should help us better to identify which clinical tasks and contexts are most susceptible and assist in the design of information systems and processes that are resilient to interruption.
A postcompletion error (PCE) is a specific kind of cognitive slip that involves omitting a final task step after the main goal of the task is accomplished. It is notoriously difficult to provoke (and hence study) slips under experimental conditions. In this paper, the authors present an experimental task paradigm that has been shown to be effective for studying PCEs in routine procedural tasks. Two studies were carried out to examine the effect of interruption position and task structure on the prevalence of PCEs. It was found that significantly more PCEs were obtained when an interruption occurred just before the PC step than when an interruption occurred at any other position in the task. The authors account for this effect in terms of Altmann and Trafton's activation-based goal memory model. The same interruption effect was obtained for some, but not all, other procedural errors; the authors discuss the nature of these errors and likely explanations for the differences.
Most electronic prescribing errors found in this study could be described as slips in using the CPOE system to create and update electronic medication charts. Cues available within the user interface may have aided resumption of interrupted tasks making CPOE systems robust to some interruption effects. Further experiments are required to rule out any effect interruption might have on CPOE error rates.
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