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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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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.