Driven to distraction

The nature and apparent purpose of interruptions in critical care and implications for HIT

Lena Mamykina, Eileen J. Carter, Barbara Sheehan, R. Stanley Hum, Bridget C. Twohig, David Kaufman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)43-54
Number of pages12
JournalJournal of Biomedical Informatics
Volume69
DOIs
StatePublished - May 1 2017

Fingerprint

Informatics
Critical Care
Nurses
Research Personnel
Physicians
Intensive care units
Pediatric Intensive Care Units
Pediatrics
Information Dissemination
Taxonomies
Observational Studies
Decision Making
Patient Care
Decision making
Display devices
Communication
Prospective Studies
Equipment and Supplies

Keywords

  • Intensive care (E02.760.190.400)
  • Interruptions
  • Observational study
  • Taxonomy/classification (L01.100)
  • workflow (L01.906.893)

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics

Cite this

Driven to distraction : The nature and apparent purpose of interruptions in critical care and implications for HIT. / Mamykina, Lena; Carter, Eileen J.; Sheehan, Barbara; Stanley Hum, R.; Twohig, Bridget C.; Kaufman, David.

In: Journal of Biomedical Informatics, Vol. 69, 01.05.2017, p. 43-54.

Research output: Contribution to journalArticle

Mamykina, Lena ; Carter, Eileen J. ; Sheehan, Barbara ; Stanley Hum, R. ; Twohig, Bridget C. ; Kaufman, David. / Driven to distraction : The nature and apparent purpose of interruptions in critical care and implications for HIT. In: Journal of Biomedical Informatics. 2017 ; Vol. 69. pp. 43-54.
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abstract = "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.",
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