Nurses' work with interruptions: an objective model for testing interventions.

Area of Science:

• Nursing
• Healthcare Operations
• Human Factors Engineering

Background:

• Interruptions disrupt nursing workflow, potentially leading to patient care errors.
• Quantitative models are needed to understand interruption dynamics and evaluate interventions.
• Nurses in a US Level I trauma center experienced frequent interruptions, impacting workflow.

Purpose of the Study:

• To develop a quantitative model of nursing work with interruptions.
• To gain insights into the causes and patterns of interruptions.
• To evaluate the effectiveness of different intervention strategies.

Main Methods:

• Direct observation of nurses in a trauma center for 47.3 hours.
• Recording of 259 interruptions across 580 nursing activities.
• Development of a stochastic, non-stationary model incorporating source and activity-dependent interruptions.

Main Results:

• Across-the-board interruption deferral during medication administration improved the beneficial/detrimental interruption ratio by 17% but increased interruptions during direct care by 73%.
• A focused intervention, deferring only cell phone interruptions during medication and direct care, improved the beneficial/detrimental interruption ratio by 31% with minimal impact on other activities.
• Modeling revealed that broad interventions can have negative consequences, while focused strategies are more advantageous.

Conclusions:

• Focused interventions, like triaging cell phone calls, are more effective than broad 'do not disturb' strategies for managing nursing interruptions.
• Understanding interruption dynamics is crucial for designing effective interventions to improve patient safety and nursing efficiency.
• Proactive strategies that anticipate nurse needs can mitigate the negative impact of interruptions.