TY - JOUR
T1 - Driven to distraction
T2 - The nature and apparent purpose of interruptions in critical care and implications for HIT
AU - Mamykina, Lena
AU - Carter, Eileen J.
AU - Sheehan, Barbara
AU - Stanley Hum, R.
AU - Twohig, Bridget C.
AU - Kaufman, David
N1 - Funding Information:
This research was supported by Grant No. 220020152 by James S. McDonnell Foundation (JSMF) for Cognitive Complexity and Error in Critical Care to Vimla L. Patel.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Objectives To examine the apparent purpose of interruptions in a Pediatric Intensive Care Unit and opportunities to reduce their burden with informatics solutions. Materials and methods In this prospective observational study, researchers shadowed clinicians in the unit for one hour at a time, recording all interruptions participating clinicians experienced or initiated, their starting time, duration, and a short description that could help to infer their apparent purpose. All captured interruptions were classified inductively on their source and apparent purpose and on the optimal representational media for fulfilling their apparent purpose. Results The researchers observed thirty-four one-hour sessions with clinicians in the unit, including 21 nurses and 13 residents and house physicians. The physicians were interrupted on average 11.9 times per hour and interrupted others 8.8 times per hour. Nurses were interrupted 8.6 times per hour and interrupted others 5.1 times per hour. The apparent purpose of interruptions included Information Seeking and Sharing (n = 259, 46.3%), Directives and Requests (n = 70, 12%), Shared Decision-Making (n = 49, 8.8%), Direct Patient Care (n = 36, 6.4%), Social (n = 71, 12.7%), Device Alarms (n = 28, 5%), and Non-Clinical (n = 10, 1.8%); 6.6% were not classified due to insufficient description. Of all captured interruptions, 29.5% were classified as being better served with informational displays or computer-mediated communication. Conclusions Deeper understanding of the purpose of interruptions in critical care can help to distinguish between interruptions that require face-to-face conversation and those that can be eliminated with informatics solutions. The proposed taxonomy of interruptions and representational analysis can be used to further advance the science of interruptions in clinical care.
AB - Objectives To examine the apparent purpose of interruptions in a Pediatric Intensive Care Unit and opportunities to reduce their burden with informatics solutions. Materials and methods In this prospective observational study, researchers shadowed clinicians in the unit for one hour at a time, recording all interruptions participating clinicians experienced or initiated, their starting time, duration, and a short description that could help to infer their apparent purpose. All captured interruptions were classified inductively on their source and apparent purpose and on the optimal representational media for fulfilling their apparent purpose. Results The researchers observed thirty-four one-hour sessions with clinicians in the unit, including 21 nurses and 13 residents and house physicians. The physicians were interrupted on average 11.9 times per hour and interrupted others 8.8 times per hour. Nurses were interrupted 8.6 times per hour and interrupted others 5.1 times per hour. The apparent purpose of interruptions included Information Seeking and Sharing (n = 259, 46.3%), Directives and Requests (n = 70, 12%), Shared Decision-Making (n = 49, 8.8%), Direct Patient Care (n = 36, 6.4%), Social (n = 71, 12.7%), Device Alarms (n = 28, 5%), and Non-Clinical (n = 10, 1.8%); 6.6% were not classified due to insufficient description. Of all captured interruptions, 29.5% were classified as being better served with informational displays or computer-mediated communication. Conclusions Deeper understanding of the purpose of interruptions in critical care can help to distinguish between interruptions that require face-to-face conversation and those that can be eliminated with informatics solutions. The proposed taxonomy of interruptions and representational analysis can be used to further advance the science of interruptions in clinical care.
KW - Intensive care (E02.760.190.400)
KW - Interruptions
KW - Observational study
KW - Taxonomy/classification (L01.100)
KW - workflow (L01.906.893)
UR - http://www.scopus.com/inward/record.url?scp=85016284816&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85016284816&partnerID=8YFLogxK
U2 - 10.1016/j.jbi.2017.01.015
DO - 10.1016/j.jbi.2017.01.015
M3 - Article
C2 - 28159645
AN - SCOPUS:85016284816
SN - 1532-0464
VL - 69
SP - 43
EP - 54
JO - Journal of Biomedical Informatics
JF - Journal of Biomedical Informatics
ER -