Improving our understanding of multi-tasking in healthcare: Drawing together the cognitive psychology and healthcare literature

Douglas, Heather; Raban, Magdalena Z.; Walter, Scott R.; Westbrook, Johanna I.

doi:10.1016/j.apergo.2016.08.021

Cited by 82 publications

(76 citation statements)

References 96 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6 However, clinicians must attend to emerging patient concerns and decide whether to address those concerns, defer them to complete EHR tasks safely, or attempt to complete both, despite multitasking risks. 3 …”

Section: Discussionmentioning

confidence: 99%

Multitasking and Silent Electronic Health Record Use in Ambulatory Visits

et al. 2017

View full text Add to dashboard Cite

to construct 3 categories of mammogram history: (1) never had a mammogram, (2) had over a year ago, and (3) had less than a year ago. We tested for differences in importance evaluations by mammogram history using ordered logit regression. Analyses applied the GfK survey weights to adjust for nonresponse bias and panel nonresponse to produce nationally-representative estimates. The study was determined to be exempt from review by the University of Minnesota institutional review board.Results | Fifty-eight (14.2%) participants reported never having a mammogram, 197 (56.4%) reported having a mammogram within the past year, and 103 (29.4%) reported having a mammogram less recently. Nearly all respondents (366, >90% for each) were aware of 4 statements describing mammography benefits (Table 1). When asked to rate their importance, most (223 [54.8]) concluded that each benefit was "very important." Respondents' awareness of harms, however, was much more variable (Table 2). Although only 108 (26.5%) reported prior awareness of overdiagnosis and 161 (39.7%) of overtreatment, 305 (74.9%) were aware of false-positive results and the potential of psychological distress. In contrast to their evaluations of benefits, fewer women rated harms as very important, ranging from 61 (15.1%) (health care system costs) to 117 (28.7%) (overtreatment). There were no statistically significant differences in awareness or ratings of importance by age group (40-49 years vs 50-59 years).Women who reported having a mammogram within the past year were significantly more likely to rate all 4 benefits as very important, compared with those who who never had a mammogram (62.4%-74.9% vs 44.9%-58.0%; differences significant at P<.05). Women who reported having a mammogram within the past year were significantly less likely to rate health care system costs and radiation harms as very important compared with those who never had a mammogram (11.5% and 15.1% vs 22.9% and 25.7%; differences significant at P<.05).Discussion | Women are more aware of the benefits of mammography screening than the harms, and women who have recently undergone mammography are more likely to judge these benefits as important. This may be owing to a lack of balanced information from physicians, 5 public health officials, news media, and disease advocacy groups that have long emphasized screening's benefits. Our findings suggest that there are opportunities for targeted education and communication at both the general public and individual levels, with a focus on educating women on the harms of screening, which they are much more likely to experience than benefits. However, the fact that women are predisposed to consider benefits as more important than harms poses a challenge to informed decision making about screening, suggesting the need for new paradigms in communicating the cumulative risks of the benefits and harms.

show abstract

Section: Discussionmentioning

confidence: 99%

Multitasking and Silent Electronic Health Record Use in Ambulatory Visits

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Table 2 provides a listing of the major subcategories of such interruptions. Multitasking was defined as performing two tasks in parallel, for example, preparing a medication while answering a question 8. Medication administration was defined as the preparation and administration of one dose to one patient.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study

Westbrook

Hooper

et al. 2017

BMJ Qual Saf

View full text Add to dashboard Cite

AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.ResultsOver 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.DiscussionNurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.

show abstract

“…There are three T1 categories. The interrupted task can stop when interrupted (T1‐A), equivalent to an externally prompted task switch . The interrupted task can continue after the interruption but stop before the end of the interrupting task (T1‐B).…”

Section: Methodsmentioning

confidence: 99%

“…The interrupted task can continue throughout the interrupting task (T1‐C). T1‐B and T1‐C are examples of concurrent externally prompted multitasking …”

Section: Methodsmentioning

confidence: 99%

“…Multiple and different strategies in addressing interruptions have been observed in the real world . Recent studies have adapted these insights into more comprehensive workflow frameworks including different interruption management strategies . In this article, we synthesize and expand upon existing interruption models and propose a three‐phase interruption framework.…”

mentioning

confidence: 99%

See 1 more Smart Citation