Visualizing the Impact of Interruptions in Nursing Workflow using a Time Process Study

DOI
  • Kasahara Satoko
    Unit of Nursing, Cluster of Medical Sciences, Faculty of Research and Education, Kochi University
  • Ohno Yuko
    Course of Health Science, Graduate School of Medicine, Osaka University
  • Ishii Atsue
    Course of Health Science, Graduate School of Medicine, Osaka University
  • Numasaki Hodaka
    Course of Health Science, Graduate School of Medicine, Osaka University

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Abstract

Interruptions have been shown in medical settings to result in errors with serious and sometimes fatal consequences. The authors conducted an observational, time-motion study to examine the pattern of changes in workflow through the drawing of flowcharts based on different timings of interruption occurrences. Nurses were observed during their day-shift operations for two weekdays in two hospital wards of a public cancer treatment hospital. Among the total of 14,453 records, 1,413 represented interruptions (9.8%). Of these, 687 records (4.8%) represented the observed nurse interrupting someone else. The analysis focuses on 703 recordings (4.9%) representing someone interrupting the observed nurse and 23 recordings (0.2%) representing self-interruptions. Nurses were interrupted an average of 6 times per hour. To understand the effect of interruptions on the workflow, the timings of the interruptions were examined. Most interruptions, 70.8%, occurred during the transition between tasks, while 24.2% while the nurse was doing a task that did not directly involve the patient. Only 5.0% of the interruptions occurred during tasks in which the nurse directly dealt with the patient. Interruptions during indirect tasks and between tasks caused nurses to perform a task in response to the interruption 95.4% and 96.9% of the time, respectively. However, only approximately half (55.6%) of interruptions during direct tasks were responded to immediately; the remaining half were postponed. There was a significant difference in the occurrences of tasks stemming from an interruption (58.3% during direct care, 32.4% during indirect care, and 23.3% between tasks). There were three times more clinical decision points in the workflow during direct care and during indirect care than during scheduled transitions between tasks.The impact of an interruption depends on its timing. To manage interruptions effectively, it is crucial to understand this timing dependence.

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