A systematic review of the psychological literature on interruption and its patient safety implications

Abstract

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.

What the work of nurses really looks like: Identifying factors influencing the work of nurses in hospital

“…The present findings point to an urgent need for the nursing community to critically discuss these issues from the point of view of professionalism, efficiency, and the safety. Theories and models used to study and explain interruptions during work are mostly linear, where only one interruption during one work activity is expected [20,22]. However, the results of this study show that this is not true for the clinical work of nurses.…”

“…The extent of influence which frequent interruptions and operational failures have on the memory and attention of nurses, and their work performance may differ between individuals. It may also depend on the work undertaken, where in the process it is interrupted, and the kind of interruption [20][21][22]. However, according to the best available knowledge to date, there are limits to how many tasks or mental activities a person can pay attention to at one time and how much information the working memory retains [18].…”

Telephone consultations in urology: Who, when, where, and why?

“…Solution proposed in the literature to decrease the disruption with phone calls interruption could be to delay the answer by asking someone to answer the pager or phone when doing a task requiring more concentration or to provide yourself with environmental cues to aid recovery from interuptions. 12 The results of our study should be interpreted in the light of some limitation. First the retrospective nature of this study introduces recall bias.…”

How do interruptions affect clinician performance in healthcare? Negotiating fidelity, control, and potential generalizability in the search for answers

“…There is a vast number of field investigations of interruptions and distractions in healthcare (see reviews by Coiera, 2012;Hopkinson & Jennings, 2013;Li, Magrabi, & Coiera, 2012;Rivera & Karsh, 2010). We have selected three to discuss : Westbrook et al's (2010) observational study of the impact of interruptions on nurses' work during medication rounds, Grundgeiger, Sanderson, MacDougall, and Venkatesh's (2010) eye-tracking study of nurses' ability to resume interrupted tasks, and Rivera's (2014) field study of how nurses make decisions to interrupt other nurses, combining ethnographic observation and interviews.…”