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DOI: 10.3414/ME11-02-0003
Challenges in Measuring the Impact of Interruption on Patient Safety and Workflow Outcomes
Publication History
received:
13 January 2011
accepted:
23 March 2011
Publication Date:
18 January 2018 (online)
Summary
Objective: To examine the problem of studying interruption in healthcare.
Methods: Review of the interruption literature from psychology, human-computer interaction; experimental studies of electronic prescribing and error behaviour; observational studies in emergency and intensive care.
Results: Primary task and interruption variables which contribute to the outcomes of an interruption include the type of task (primary and interrupting task); point of interruption; duration of interruption; similarity of interruptive task to primary task; modality of interruption; environmental cues; and interruption handling strategy. Effects of interruption on task performance can be examined by measuring errors, the time on task, interruption lag and resumption lag.
Conclusions: Interruptions are a complex phenomenon where multiple variables including the characteristics of primary tasks, the interruptions themselves, and the environment may influence patient safety and work-flow outcomes. Observational studies present significant challenges for recording many of the process variables that influence the effects of interruptions. Controlled experiments provide an opportunity to examine the specific effects of variables on errors and efficiency. Computational models can be used to identify the situations in which interruptions to clinical tasks could be disruptive and to investigate the aggregate effects of interruptions.
Keywords
Interruption - medical error - safety - efficiency - evaluation studies - observation - computer simulation* This research was carried out when Simon Y. W. Li was at the Centre for Health Informatics, University of New South Wales. He is now at the Department of Sociology & Social Policy, Lingnan University, Hong Kong
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References
- 1 Coiera E. Clinical communication: a new informatics paradigm. Proc AMIA Annu Fall Symp 1996 pp 17-21.
- 2 Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study. BMJ 1998; 316 7132 673-676.
- 3 Pirnejad H, Niazkhani Z, Berg M. et al. Intra- organizational communication in healthcare – considerations for standardization and ICT application. Methods Inf Med 2008; 47 (04) 336-345.
- 4 Grundgeiger T, Sanderson P. Interruptions in healthcare: theoretical views. Int J Med Inform 2009; 78 (05) 293-307.
- 5 Parker J, Coiera E. Improving clinical communication: a view from psychology. J Am Med Inform Assoc 2000; 7 (05) 453-461.
- 6 Altmann EM, Trafton JG. Timecourse of recovery from task interruption: Data and a model. Psycho-nomic Bulletin & Review 2007; 14 (06) 1079-1084.
- 7 Zhan C, Hicks RW, Blanchette CM. et al. Potential benefits and problems with computerized prescriber order entry: analysis of a voluntary medication error-reporting database. Am J Health Syst Pharm 2006; 63 (04) 353-358.
- 8 Ashcroft DM, Quinlan P, Blenkinsopp A. Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies. Pharmacoepidemiol Drug Saf 2005; 14 (05) 327-332.
- 9 Spencer R, Coiera E, Logan P. Variation in communication loads on clinical staff in the emergency department. Ann Emerg Med 2004; 44 (03) 268-273.
- 10 Rivera-Rodriguez AJ, Karsh BT. Interruptions and distractions in healthcare: review and reappraisal. Qual Saf Health Care 2010
- 11 Westbrook JI, Coiera E, Dunsmuir WT. et al. The impact of interruptions on clinical task completion. Qual Saf Health Care 2010
- 12 Westbrook JI, Woods A, Rob MI. et al. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010; 170 (08) 683-690.
- 13 Bailey BP, Konstan JA, Carlis JV. editors. The effects of interruptions on task performance, annoyance, and anxiety in the user interface. Human-Computer Interaction – INTERACT 2001 Conf Proc; 2001
- 14 Latorella KA. Investigating interruptions: An example from the flightdeck. Proc of the Human Factors and Ergonomics Society 40th Annual Meeting 1996 pp 249-253.
- 15 Cades DM, Werner N, Trafton JG. et al. Dealing with Interruptions can be Complex, but does Interruption Complexity Matter: a Mental Resources Approach to Quantifying Disruptions. Proc of the Human Factors and Ergonomics Society 52nd Annual Meeting 2008
- 16 Oulasvirta A, Saariluoma P. Long-term working memory and interrupting messages in human-computer interaction. Behaviour & Information Technology 2004; 23 (01) 53.
- 17 Altmann EM, Trafton JG. Task interruption: Resumption lag and the role of cues. Proc of the 26th annual conference of the Cognitive Science Society 2004
- 18 Edwards MB, Gronlund SD. Task interruption and its effects on memory. Memory 1998; 6 (06) 665-687.
- 19 Monk CA, Trafton JG, Boehm-Davis DA. The effect of interruption duration and demand on resuming suspended goals. J of Experimental Psychology: Applied 2008; 14 (04) 299-313.
- 20 Adamczyk PD, Bailey BP. If not now, when?. The effects of interruption at different moments within task execution. Proc of the SIGCHI conference on Human factors in computing systems; Vienna, Austria: ACM; 2004
- 21 Arroyo E, Selker T, Stouffs A. editors. Interruptions as multimodal outputs: which are the less disruptive?. Proc Fourth IEEE International Conference on Multimodal Interfaces; 2002 pp 179-482.
- 22 Speier C, Vessey I, Valacich JS. The influence of task interruption on individual decision making: An information overload perspective. Decision Sciences 1999; 30 (02) 24.
- 23 Speier C, Vessey I, Valacich JS. The effects of interruptions, task complexity, and information presentation on computer-supported decision-making performance. Decision Sciences 2003; 34 (04) 771-797.
- 24 Trafton JG, Altmann EM, Brock DP. Huh, What Was I Doing?. How People Use Environmental Cues after an Interruption. Proc of the Human Factors and Ergonomics Society 49th Annual Meeting, Orlando, Florida, September 2005 pp 468-472.
- 25 Trafton JG, Altmann EM, Brock DP. et al. Preparing to Resume an Interrupted Task: Effects of Prospective Goal Encoding and Retrospective Rehearsal. Int J of Human-Computer Studies 2003; 58 (05) 583-603.
- 26 Magrabi F, Li SY, Day RO. et al. Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects. J Am Med Inform Assoc 2010; 17 (05) 575-583.
- 27 Li SYW, Blandford A, Cairns P. et al. The Effect of Interruptions on Postcompletion and Other Procedural Errors: An Account Based on the Activation-Based Goal Memory Model. J of Experimental Psychology: Applied 2008; 14 (04) 314-328.
- 28 Alvarez G, Coiera E. Interruptive communication patterns in the intensive care unit ward round. Int J Med Inform 2005; Oct 74 (10) 791-6.
- 29 Coiera EW, Jayasuriya RA, Hardy J. et al. Communication loads on clinical staff in the emergency department. Med J Aust 2002; May 6 176 (09) 415-8.
- 30 Runciman W, Hibbert P, Thomson R. et al. Towards an International Classification for Patient Safety: key concepts and terms. Int J Qual Health Care 2009; Feb 21 (01) 18-26.
- 31 Magrabi F. Using cognitive models to evaluate safety-critical interfaces in healthcare. CHI ’08 extended abstracts on Human factors in computing systems, Florence, Italy. ACM; 2008
- 32 Wood RE. Task complexity: Definition of the construct. Org Behav Human Dec Process 1986; 37: 60-82.
- 33 Sintchenko V, Coiera E. Decision complexity affects the extent and type of decision support use. AMIA Annu Symp Proc 2006 pp 724-728.
- 34 Byrne MD, Bovair S. A working memory model of a common procedural error. Cognitive Science 1997; 1997/3//; 21 (01) 31-61.
- 35 Grundgeiger T, Sanderson P, Macdougall HG. et al. Interruption management in the intensive care unit: Predicting resumption times and assessing distributed support. J Exp Psychol Appl 2010; 16 (04) 317-334.
- 36 Dahl Y. “You have a message here”: enhancing interpersonal communication in a hospital ward with location-based virtual notes. Methods Inf Med 2006; 45 (06) 602-609.
- 37 Tullis T, Albert A. Measuring the user experience: collecting, analyzing, and presenting usability metrics. Elsevier Inc; 2008
- 38 Collins S, Currie L, Patel V. et al. Multitasking by clinicians in the context of CPOE and CIS use. Stud Health Technol Inform 2007; 129 Pt (02) 958-962.
- 39 Ratwani R, Trafton JG. An eye movement analysis of the effect of interruption modality on primary task resumption. Hum Factors 2010; 52 (03) 370-380.
- 40 Ginsburg G. Interruptions: A Criterion in the Design and Evaluation of Human-Computer Interfaces. University of Toronto; 2004
- 41 Liu D, Grundgeiger T, Sanderson PM. et al. Interruptions and blood transfusion checks: lessons from the simulated operating room. Anesth Analg 2009; 108 (01) 219-222.
- 42 Faul F, Erdfelder E, Lang AG. et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191.
- 43 van Doormaal JE, van den Bemt PM, Mol PG. et al. Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients. Qual Saf Health Care 2009; 18 (01) 22-27.
- 44 Runciman WB, Merry A, Walton M. Safety and Ethics in Healthcare: a guide to getting it right. Ash-gate Publishing; 2007
- 45 Fone D, Hollinghurst S, Temple M. et al. Systematic review of the use and value of computer simulation modelling in population health and health care delivery. J Public Health Med 2003; 25 (04) 325-335.
- 46 Epstein JM. Why Model?. Journal of Artificial Societies and Social Simulation 2008: 11.
- 47 Alexopoulos C, Goldsman D, Wilson JR. et al. Opportunities and Challenges in Health Care Simulation. Advancing the Frontiers of Simulation: Springer US; 2009 pp 195-229.
- 48 Hall RW, Jacobson SH, Hall SN. et al. Discrete-Event Simulation of Health Care Systems. Patient Flow: Reducing Delay in Healthcare Delivery: Springer US; 2006 pp 211-252.
- 49 Barlas Y. Formal aspects of model validity and validation in system dynamics. System Dynamics Review 1996; 12 (03) 183-210.
- 50 Sierhuis M, Jonker C, Riemsdijk Bv. et al. Towards Organization Aware Agent-based Simulation. International Journal of Intelligent Control and Systems 2009; 14 (01) 62-76.