Interruptions and Blood Transfusion Checks: Lessons from the Simulated Operating Room

Abstract

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.

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

“…They help investigators clarify the conditions under which interruptions may or may not produce harm. Simulator-based investigations may be mounted in a full-scale healthcare simulation environment (Feuerbacher, Funk, Spight, Diggs, & Hunter, 2012;Liu, Grundgeiger, Sanderson, Jenkins, & Leane, 2009;Prakash et al, 2014) or in a part-task simulation environment (Magrabi, Li, Day, & Coiera, 2010). They typically involve clinicians as participants.…”

“…In addition, the simulated situation becomes less representative in studies that constrain subject matter experts in the kind of interruption management strategies they can use (Magrabi et al, 2010). The Prakash et al (2014) study solves the above issues by using naturalistic scenarios and introducing interruptions as actions by other actors, such as telephone calls or requests from other nurses or from patients (all actors) to distract or interrupt, thereby using content that is consistent with the presented scenarios (Grundgeiger et al, 2013;Liu et al, 2009).…”

“…To insure internal validity, within-participant designs should report how potential order effects are handled. Such an analysis, however, is difficult if the total number of participants and the number of observation per participants are low (Grundgeiger et al, 2013;Liu et al, 2009;Merry et al, 2008). Between-participants manipulations provide stronger conclusions.…”

“…Importantly, participants were given discretionary control on exactly when they could answer the phone. Discretionary control of interruption management has been shown to be an important factor in healthcare (Colligan & Bass, 2012;Grundgeiger et al, 2010;Liu et al, 2009) but laboratory studies frequently constrain participants' behaviour. Investigators performing laboratory-based research that is intended to generalize to healthcare tasks should conduct a cognitive task analysis (Hoffman & Militello, 2008) of the healthcare tasks to ensure that properties of the healthcare task that are likely to be affected by interruptions have structural analogs in the laboratory task.…”

Interruptions, visual cues, and the microstructure of interaction: Four laboratory studies

“…In the literature, definitions of interruptions typically note the unexpected nature of the interruption and the prompt cessation of the task at hand due to the interrupting task (Brixey et al, 2007;Trafton et al, 2003). However, further studies report that participants use discretionary interruption management strategies; such strategies include immediately engaging with the interrupting task, as described above, but also include deferring or blocking the interrupting task (Bogunovich and Salvucci, 2011;Colligan and Bass, 2012;Grundgeiger et al, 2010;Liu et al, 2009;Salvucci and Bogunovich, 2010). In the present paper, we investigated whether the presentation of subtle visual cues, emphasizing the remaining steps of a procedural task, can influence how humans manage interruptions.…”