Interruptions, task completion and error

Interruptions, task completion and error

Westbrook JI, et.al. The impact of interruptions on clinical task completion. Qual Saf Health Care. 2010 Aug;19(4):284-9. Epub 2010 May 12. ( PubMed | Journal )

Background Interruptions and multitasking are implicated as a major cause of clinical inefficiency and error.

Objective The aim was to measure the association between emergency doctors' rates of interruption and task completion times and rates.

Methods The authors conducted a prospective observational time and motion study in the emergency department of a 400-bed teaching hospital. Forty doctors (91% of medical staff) were observed for 210.45 h on weekdays. The authors calculated the time on task (TOT); the relationship between TOT and interruptions; and the proportion of time in work task categories. Length-biased sampling was controlled for.

Results Doctors were interrupted 6.6 times/h. 11% of all tasks were interrupted, 3.3% more than once. Doctors multitasked for 12.8% of time. The mean TOT was 1:26 min. Interruptions were associated with a significant increase in TOT. However, when length-biased sampling was accounted for, interrupted tasks were unexpectedly completed in a shorter time than uninterrupted tasks. Doctors failed to return to 18.5% (95% CI 15.9% to 21.1%) of interrupted tasks.

Conclusions It appears that in busy interrupt-driven clinical environments, clinicians reduce the time they spend on clinical tasks if they experience interruptions, and may delay or fail to return to a significant portion of interrupted tasks. Task shortening may occur because interrupted tasks are truncated to ‘catch up’ for lost time, which may have significant implications for patient safety.

Comment: Like the effect of alertness and fatigue on task performance, interruptions are now under study to determine the effect on error in the clinical setting. No surprise, clinical work seems subject to the same kinds of problems as have been shown for human performance generally and in other work fields. This is just one study, and not in the NICU, but it points to an important opportunity for improvement. In the same issue of this journal a systematic review examined 33 studies of interruption in healthcare settings. Similar results were found in another study of physicians and specifically physician communication. Among other studies of interruption is one of nurse task performance and evaluations of countermeasures to prevent interruption such as this one by establishing no interruption zones to help prevent medication errors.

Some interruptions are no doubt necessary for safe care, but the rate of interruption and the established adverse effect on error potential during task performance suggest efforts to reduce interruption are important in improving safety. Have you attempted countermeasures to limit interruptions to staff during safety-critical task performance? What effect does a move to single patient rooms have on staff interruptions? Please share your experience.