The impact of interruptions on clinical task completion

• Published in: Quality & safety in health care Vol. 19; no. 4; pp. 284 - 289
• Main Authors: Westbrook, Johanna I, Coiera, Enrico, Dunsmuir, William T M, Brown, Bruce M, Kelk, Norm, Paoloni, Richard, Tran, Cuong
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.08.2010; BMJ Publishing Group LTD
• Subjects: Adult; Australia; Behavior; Communication; Documentation; Efficiency, Organizational - statistics & numerical data; emergency department; Emergency medical care; Emergency Medical Services - standards; Female; Health administration; Hospital Bed Capacity, 300 to 499; Hospitals; Hospitals, Teaching; Humans; Male; Medical records; Middle Aged; Multitasking; Patient Safety; Physicians; Physicians - statistics & numerical data; Prospective Studies; quality of care; Studies; Task Performance and Analysis; Time and Motion Studies; Australia
• ISSN: 1475-3898; 1475-3901
• DOI: 10.1136/qshc.2009.039255

BackgroundInterruptions and multitasking are implicated as a major cause of clinical inefficiency and error.ObjectiveThe aim was to measure the association between emergency doctors' rates of interruption and task completion times and rates.MethodsThe 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.ResultsDoctors 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.ConclusionsIt 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.