The relationship between interruption content and interrupted task severity in intensive care nursing: an observational study
Introduction
Interruptions experienced by intensive care unit (ICU) nurses are being studied widely due to their prevalence (Tucker and Spear, 2006) and their potentially negative effects on nurses’ performance (Ballermann et al., 2010, Drews, 2007, Grundgeiger et al., 2010). However, not all interruptions are necessarily negative, and in certain contexts, ICU nurses may benefit from interruptions that communicate information related to patients, tasks, or decisions-at-hand (Coiera and Tombs, 1998, Grundgeiger and Sanderson, 2009, Rivera-Rodriguez and Karsh, 2010, Sasangohar et al., 2012, Walji et al., 2004). For example, ICU alarms (e.g., from intravenous pumps) can indicate an off-normal condition that needs immediate attention, or a nurse can interrupt another nurse to communicate an important event (e.g., patient arrival, hand-overs).
An earlier study we conducted in a Canadian Cardiovascular ICU (CVICU) revealed that the majority of the observed interruptions conveyed patient- or work-related content (Sasangohar et al., 2014). Therefore, mitigation strategies aimed at blocking interruptions with no consideration for interruption content may disrupt the communication of potentially important information. Overall, the interactions between the context in which interruptions happen (e.g., sources of interruption, tasks being interrupted), the interruption content (e.g., information conveyed, purpose of interruption), and the interruption characteristics (e.g., frequency and duration) can provide insights into developing more situation-specific mitigation approaches (Sasangohar et al., 2014). For example, non-urgent, non-task-relevant interruptions should be delayed or blocked during high-severity or highly critical tasks, whereas urgent or task-relevant interruptions might be allowed during low-severity tasks that are not as critical.
In our earlier CVICU study (Sasangohar et al., 2014), we observed that the staff's (e.g., nurses, MDs, other services) interruption behavior varied as a function of primary task severity (high, medium, or low) and interruption content (personal, patient-related, or work-related). To define the former variable, four experienced nurses were asked to categorize CVICU tasks as having high-, medium-, or low-severity outcomes in case of an error. The nurses responded individually, and the mode response was chosen for task severity. Overall, the proportion of interruptions with personal content was observed to be higher during low-severity tasks, compared to medium- and high-severity tasks. These results reveal a certain level of intuitive task-severity awareness among the interrupters, suggesting that a deliberate attempt at making task severity more transparent may help others modulate when and how they interrupt a nurse. However, this earlier study had a significant limitation in that the primary tasks were only recorded when an interruption happened and thus did not capture the prevalence of non-interrupted tasks. Previous studies have shown variation in the percentage of time nurses spend performing different ICU tasks. For example, Keohane et al. (2008) reported that about 10% of ICU tasks they observed were documentation, whereas Wong et al. (2003) reported documentation to be around 35%.
This methodological limitation was addressed in a second observational study conducted at the same CVICU. In this second study, we collected contextual information about the nurses’ primary tasks in addition to the interruptions they experience in order to assess whether occurrence of interruptions varies as a function of primary task severity and interruption content. The overall objective of this second study was to further investigate interruptions and to also evaluate the effectiveness of an interruption mitigation tool, which was installed in one of the 24 rooms of this CVICU. The baseline data (i.e., data collected in 11 rooms without the tool) are used in this paper to validate the findings of the first observational study and also to report the make-up of different ICU tasks we observed. The findings on the effectiveness of the mitigation tool are presented in Sasangohar et al. (in press).
Section snippets
Methods
The CVICU of a Canadian hospital affiliated with the University of Toronto, Faculty of Medicine was observed weekdays over a 3-week period. The unit is a 24-bed closed CVICU that only accepts cardiovascular or vascular (both elective and emergent) surgery patients. The number of patients within the unit varies over the week, with about 12 patients cared for on Sunday, 16 on Monday, 20 on Tuesday, and 22 for the rest of the week. The study was approved by the Research Ethics Board of this
Primary tasks
Overall, 827 primary task activities were observed. Of these activities, 256 (31%) involved discussion with other personnel, 166 (20%) were documentation, 81 (10%) involved general care, and 64 (8%) were procedures (Fig. 2a). Nurses spent almost half of their time communicating with other personnel (26%) and documenting (23%) (Fig. 2b). They spent 15% of their time conducting procedures and 10% providing general care. Both Fig. 2a and b categorize these different primary tasks in terms of
Discussion
As part of a larger observational study which also evaluated the effectiveness of an interruption mitigation tool in a CVICU setting, 13 nurses were observed in a baseline condition (i.e., in rooms with no tool). The total observation time for these nurses was 19 h during which the primary tasks performed by the nurses as well as the interruptions that they experienced were recorded. The results showed that nurses spent most of their time communicating with other staff (26%) and doing
Acknowledgments
We gratefully acknowledge Helen Storey for providing domain expertise and her help in facilitating data collection. We also would like to thank Dr. Mark Chignell and Dr. Linda McGillis Hall for their insightful feedback, and Parya Noban, Sahar Ameri, and Areeba Zakir for their help in data collection and analysis. The study sponsors were not involved in the conduct of this research.
Conflict of interest. The authors have no conflicts of interest regarding this research.
Funding. This research was
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2021, International Emergency NursingCitation Excerpt :There were 40,300 patients visiting in ED annually while there were 74,000–80,000 patients visiting in ED annually in the United States and Germany which extrapolates that higher patients could result in higher level of interruptions in ED. The frequency of interruptions experienced by surgical ward nurses was 5.6 times per hour [14], and that of intensive care unit nurses was 5.0 times per hour [15], both of which are lower than the findings in this study. In this study, the time consumed by interruptions was calculated as the ratio of time of interruptions to the time required for nursing tasks (B/A).
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2018, Intensive and Critical Care NursingCitation Excerpt :Within the intensive care environment, it has been demonstrated that not all interruptions are detrimental to patient safety. Sasangohar et al. (2015) identified that some interruptions related to the communication of important information about a task or patient. Furthermore, Sasangohar et al. (2015) identified that interruptions which included personal conversation occurred more frequently during low severity tasks (which did not include medication administration).
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2017, International Journal of Nursing StudiesCitation Excerpt :Although the overwhelming focus in this blended cluster is one of interruptions creating the potential for error, a number of papers do note that interruptions are not always negative (Hopkinson and Jennings, 2013; Chisholm et al., 2000; Friedman et al., 2005; Healey et al., 2006, 2007; Biron et al., 2009b; Trbovich et al., 2013; Berg et al., 2013; Sorensen and Brahe, 2013; Sasangohar et al., 2015a, 2014; Myers et al., 2015; Hayes et al., 2015; Allers et al., 2016; Walter et al., 2017). Within this cluster can often be found a broader discussion of the systems context in which interruptions occur (Biron et al., 2009a,b; Hopkinson and Jennings, 2013; Tucker and Spear, 2006; Friedman et al., 2005; Healey et al., 2006, 2007; Trbovich et al., 2013; Sasangohar et al., 2015a; Fairbanks et al., 2007; Wiegmann et al., 2007). There is a strong initial statement in Healey et al. (2007) to this effect.