Research Article | Open Access
Matthias Weigl, Severin Hornung, Jürgen Glaser, Peter Angerer, "Reduction of Hospital Physicians' Workflow Interruptions: A Controlled Unit-Based Intervention Study", Journal of Healthcare Engineering, vol. 3, Article ID 840786, 16 pages, 2012. https://doi.org/10.1260/2040-22220.127.116.115
Reduction of Hospital Physicians' Workflow Interruptions: A Controlled Unit-Based Intervention Study
Highly interruptive clinical environments may cause work stress and suboptimal clinical care. This study features an intervention to reduce workflow interruptions by re-designing work and organizational practices in hospital physicians providing ward coverage. A prospective, controlled intervention was conducted in two surgical and two internal wards. The intervention was based on physician quality circles - a participative technique to involve employees in the development of solutions to overcome work-related stressors. Outcome measures were the frequency of observed workflow interruptions. Workflow interruptions by fellow physicians and nursing staff were significantly lower after the intervention. However, a similar decrease was also observed in control units. Additional interviews to explore process-related factors suggested that there might have been spill-over effects in the sense that solutions were not strictly confined to the intervention group. Recommendations for further research on the effectiveness and consequences of such interventions for professional communication and patient safety are discussed.
- T. Grundgeiger and P. Sanderson, “Interruptions in healthcare: theoretical views,” Int J Med Inform, vol. 78, no. 5, pp. 293–307, 2009.
- A. J. Rivera-Rodriguez and B. T. Karsh, “Interruptions and distractions in healthcare: review and reappraisal,” Qual Saf Health Care, vol. 19, no. 4, pp. 304–312, 2010.
- C. D. Chisholm, A. M. Dornfeld, D. R. Nelson, and W. H. Cordell, “Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices,” Ann Emerg Med, vol. 38, no. 2, pp. 146–151, 2001.
- A. Dearden, M. Smithers, and A. Thapar, “Interruptions during general practice consultations - the patients' view,” Fam Pract, vol. 13, no. 2, pp. 166–169, 1996.
- E. O'Shea, “Factors contributing to medication errors: a literature review,” J Clin Nurs, vol. 8, no. 5, pp. 496–504, 1999.
- E. Coiera and V. Tombs, “Communication behaviours in a hospital setting: an observational study,” Bmj, vol. 316, no. 7132, pp. 673–676, 1998.
- B. J. Kalisch and M. Aebersold, “Interruptions and multitasking in nursing care,” Jt Comm J Qual Patient Saf, vol. 36, no. 3, pp. 126–132, 2010.
- Q. R. Jett and J. M. George, “Work interrupted: A closer look at the role of interruptions in organizational life,” Acad Manage Rev, vol. 28, no. 3, pp. 494–507, 2003.
- A. F. Hakimzada, R. A. Green, O. R. Sayan, J. Zhang, and V. L. Patel, “The nature and occurrence of registration errors in the emergency department,” Int J Med Inform, vol. 77, no. 3, pp. 169–175, 2008.
- D. A. Wiegmann, A. W. ElBardissi, J. A. Dearani, R. C. Daly, and T. M. I. Sundt, “Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation,” Surgery, vol. 142, no. 5, pp. 658–665, 2007.
- J. I. Westbrook, E. Coiera, W. T. Dunsmuir, B. M. Brown, N. Kelk, R. Paoloni et al., “The impact of interruptions on clinical task completion,” Qual Saf Health Care, vol. 19, no. 4, pp. 284–289, 2010.
- J. J. Brixey, Z. Tang, D. J. Robinson, C. W. Johnson, T. R. Johnson, J. P. Turley et al., “Interruptions in a level one trauma center: a case study,” Int J Med Inform, vol. 77, no. 4, pp. 235–241, 2008.
- N. Sevdalis, A. Sonal, S. Undre, and C. A. Vincent, “Distractions and Interruptions in the Operating Room,” in Safer Surgery, R. Flin and L. Mitchell, Eds., pp. 405–419, Ashgate, Farnham, 2009.
- E. A. Flynn, K. N. Barker, J. T. Gibson, R. E. Pearson, B. A. Berger, and L. A. Smith, “Impact of interruptions and distractions on dispensing errors in an ambulatory care pharmacy,” Am J Health Syst Pharm, vol. 56, no. 13, pp. 1319–1325, 1999.
- J. I. Westbrook, A. Woods, M. I. Rob, W. T. Dunsmuir, and R. O. Day, “Association of interruptions with an increased risk and severity of medication administration errors,” Arch Intern Med, vol. 170, no. 8, pp. 683–690, 2010.
- A. D. Biron, C. G. Loiselle, and M. Lavoie-Tremblay, “Work interruptions and their contribution to medication administration errors: an evidence review,” Worldviews Evid Based Nurs, vol. 6, no. 2, pp. 70–86, 2009.
- M. Weigl, A. Muller, A. Zupanc, J. Glaser, and P. Angerer, “Hospital doctors' workflow interruptions and activities: an observation study,” BMJ Qual Saf, vol. 20, no. 6, pp. 491–497, 2011.
- S. Y. Li, F. Magrabi, and E. Coiera, “A systematic review of the psychological literature on interruption and its patient safety implications,” J Am Med Inform Assoc, vol. 19, no. 1, pp. 6–12, 2012.
- E. Relihan, V. O'Brien, S. O'Hara, and B. Silke, “The impact of a set of interventions to reduce interruptions and distractions to nurses during medication administration,” Qual Saf Health Care, vol. 19, no. 5, pp. 1–6, 2010.
- T. M. Pape, “Applying airline safety practices to medication administration,” Medsurg Nurs, vol. 12, no. 2, pp. 77–93, 2003.
- M. A. Ballermann, N. T. Shaw, K. J. Arbeau, D. C. Mayes, and R. T. Noel Gibney, “Impact of a critical care clinical information system on interruption rates during intensive care nurse and physician documentation tasks,” Stud Health Technol Inform, vol. 160, Pt 1, pp. 274–278, 2010.
- R. Peleg, M. Froimovici, A. Peleg, V. Milrad, G. Ohana, S. Fitoussi et al., “Interruptions to the physician-patient encounter: an intervention program,” Isr Med Assoc J, vol. 2, no. 7, pp. 520–522, 2000.
- T. M. Pape, D. M. Guerra, M. Muzquiz, J. B. Bryant, M. Ingram, B. Schranner et al., “Innovative approaches to reducing nurses' distractions during medication administration,” J Contin Educ Nurs, vol. 36, no. 3, pp. 108–116, 2005.
- A. Laxmisan, F. Hakimzada, O. R. Sayan, R. A. Green, J. Zhang, and V. L. Patel, “The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care,” Int J Med Inform, vol. 76, no. 11-12, pp. 801–811, 2007.
- D. van Eerd, D. Cole, E. Irvin, Q. Mahood, K. Keown, N. Theberge et al., “Process and implementation of participatory ergonomic interventions: a systematic review,” Ergonomics, vol. 53, no. 10, pp. 1153–1166, 2010.
- I. Rivilis, D. Van Eerd, K. Cullen, D. C. Cole, E. Irvin, J. Tyson et al., “Effectiveness of participatory ergonomic interventions on health outcomes: A systematic review,” Applied Ergonomics, vol. 39, no. 3, pp. 342–358, 2008.
- M. Weigl, J. Glaser, S. Hornung, and P. Angerer, “Gestaltung ärztlicher Arbeit im Krankenhaus: Intervention und Evaluation (Design of medical work in the hospital: Intervention and Evaluation,” in Arbeitsbedingungen und Befinden von Ärztinnen und Ärzten (Work conditions and Well-being of Physicians), F. W. Schwartz and P. Angerer, Eds., pp. 359–371, DAEV, Cologne, 2009.
- G. M. Pereira and H. G. Osburn, “Effects of participation in decision making on performance and employee attitudes: A quality circles meta-analysis,” J Bus Psychol, vol. 22, no. 2, pp. 145–153, 2007.
- B. Aust and A. Ducki, “Comprehensive health promotion interventions at the workplace: experiences with health circles in Germany,” J Occup Health Psychol, vol. 9, no. 3, pp. 258–270, 2004.
- S. A. Finkler, J. R. Knickman, G. Hendrickson, M. Lipkin Jr., and W. G. Thompson, “A comparison of work-sampling and time-and-motion techniques for studies in health services research,” Health Serv Res, vol. 28, no. 5, pp. 577–597, 1993.
- J. Carthey, “The role of structured observational research in health care,” Qual Saf Health Care, vol. 12, no. 2, pp. ii13–ii16, 2003.
- E. J. Thomas, J. B. Sexton, and R. L. Helmreich, “Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation,” Qual Saf Health Care, vol. 13, no. 1, pp. i57–i64, 2004.
- C. D. Chisholm, E. K. Collison, D. R. Nelson, and W. H. Cordell, “Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”?” Acad Emerg Med, vol. 7, no. 11, pp. 1239–1243, 2000.
- V. Gilchrist, G. McCord, S. L. Schrop, B. D. King, K. F. McCormick, A. M. Oprandi et al., “Physician activities during time out of the examination room,” Ann Fam Med, vol. 3, no. 6, pp. 494–499, 2005.
- M. Weigl, A. Muller, A. Zupanc, and P. Angerer, “Participant observation of time allocation, direct patient contact, and simultaneous activities in hospital physicians,” BMC Health Serv Res, vol. 9, no. 1, 110, 2009.
- J. R. Landis and G. G. Koch, “Measurement of Observer Agreement for Categorical Data,” Biometrics, vol. 33, no. 1, pp. 159–174, 1977.
- J. Cohen, Statistical power analysis for the behavioral sciences, L. Erlbaum Associates, 1988.
- J. I. Westbrook, A. Ampt, L. Kearney, and M. I. Rob, “All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time,” Med J Aust, vol. 188, no. 9, pp. 506–509, 2008.
- A. M. Grant and T. D. Wall, “The Neglected Science and Art of Quasi-Experimentation Why-to, When-to, and How-to Advice for Organizational Researchers,” Organ Res Methods, vol. 12, no. 4, pp. 653–686, 2009.
- D. J. France, S. Levin, R. Hemphill, K. Chen, D. Rickard, R. Makowski et al., “Emergency physicians' behaviors and workload in the presence of an electronic whiteboard,” Int J Med Inform, vol. 74, no. 10, pp. 827–837, 2005.
- M. Weigl, A. Müller, C. Vincent, P. Angerer, and N. Sevdalis, “The association of workflow interruptions and hospital doctors' workload: a prospective observational study,” BMJ Quality & Safety, vol. 21, no. 5, pp. 399–407, 2012.
- S. Kreckler, K. Catchpole, M. Bottomley, A. Handa, and P. McCulloch, “Interruptions during drug rounds: an observational study,” Br J Nurs, vol. 17, no. 21, pp. 1326–1330, 2008.
- J. J. Brixey, D. J. Robinson, J. P. Turley, and J. Zhang, “The roles of MDs and RNs as initiators and recipients of interruptions in workflow,” Int J Med Inform, pp. e109–e115, 2010.
- J. J. Brixey, D. J. Robinson, C. W. Johnson, T. R. Johnson, J. P. Turley, and J. Zhang, “A concept analysis of the phenomenon interruption,” ANS Adv Nurs Sci, vol. 30, no. 1, pp. E26–E42, 2007.
- A. N. Healey, N. Sevdalis, and C. A. Vincent, “Measuring intra-operative interference from distraction and interruption observed in the operating theatre,” Ergonomics, vol. 49, no. 5-6, pp. 589–604, 2006.
- N. Sevdalis, D. Forrest, S. Undre, A. Darzi, and C. Vincent, “Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI),” World J Surg, vol. 32, no. 8, pp. 1643–1650, 2008.
- E. S. Patterson, E. M. Roth, D. D. Woods, R. Chow, and J. O. Gomes, “Handoff strategies in settings with high consequences for failure: lessons for health care operations,” Int J Qual Health Care, vol. 16, no. 2, pp. 125–132, 2004.
- J. S. Martin, W. Ummenhofer, T. Manser, and R. Spirig, “Interprofessional collaboration among nurses and physicians: making a difference in patient outcome,” Swiss Med Wkly, vol. 140, w13062, 2010.
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