Workflow interruptions and mental workload in hospital pediatricians: an observational study

BMC Health Services Research

Florian Hoffmann¹  Peter Angerer³  Andreas Müller³  Matthias Weigl² 

[1]Dr. von Hauner University Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany

[2]Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany

[3]Institute for Occupational and Social Medicine, University of Düsseldorf, Düsseldorf, Germany

关键词: Work life;    Observation;    Hospital pediatricians;    Workload;    Workflow interruptions;   

Others  :  1126163
DOI  :  10.1186/1472-6963-14-433

 received in 2014-05-22, accepted in 2014-09-11,  发布年份 2014

【 摘 要 】

Background

Pediatricians’ workload is increasingly thought to affect pediatricians’ quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians’ attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts.

Methods

In an Academic Children’s Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians’ workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration.

Results

Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload.

Conclusions

The findings provide insights into specific pathways between different types of interruptions and pediatricians’ mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care.

【 授权许可】

   
2014 Weigl et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL: The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform 2007, 76:801-811.
• [2]Sevdalis N, Forrest D, Undre S, Darzi A, Vincent C: Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI). World J Surg 2008, 32:1643-1650.
• [3]Westbrook JI, Ampt A, Kearney L, Rob MI: 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 2008, 188:506-509.
• [4]Chisholm CD, Dornfeld AM, Nelson DR, Cordell WH: Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. Ann Emerg Med 2001, 38:146-151.
• [5]Antoniadis S, Passauer-Baierl S, Baschnegger H, Weigl M: Identification and interference of intraoperative distractions and interruptions in operating rooms. J Surg Res 2014, 188:21-29.
• [6]Walter SR, Li L, Dunsmuir WT, Westbrook JI: Managing competing demands through task-switching and multitasking: a multi-setting observational study of 200 clinicians over 1000 hours. BMJ Qual Saf 2014, 23:231-241.
• [7]Weigl M, Müller A, Sevdalis N, Angerer P: Relationships of multitasking, physicians’ strain, and performance: an observational study in ward physicians. J Patient Saf 2013, 9:18-23.
• [8]O’Shea E: Factors contributing to medication errors: a literature review. J Clin Nurs 1999, 8:496-504.
• [9]Westbrook JI, Coiera E, Dunsmuir WT, Brown BM, Kelk N, Paoloni R, Tran C: The impact of interruptions on clinical task completion. Qual Saf Health Care 2010, 19:284-289.
• [10]Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO: Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010, 170:683-690.
• [11]Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TMI: Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery 2007, 142:658-665.
• [12]Hakimzada AF, Green RA, Sayan OR, Zhang J, Patel VL: The nature and occurrence of registration errors in the emergency department. Int J Med Inform 2008, 77:169-175.
• [13]Jett QR, George JM: Work interrupted: a closer look at the role of interruptions in organizational life. Acad Manage Rev 2003, 28:494-507.
• [14]Coiera E: The science of interruption. BMJ Qual Saf 2012, 21:357-360.
• [15]Hart SG, Staveland LE, Hancock PA, Meshkati N: Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research. In Human Mental Workload. Oxford England: North-Holland; 1988:139-183. Advances in psychology, 52
• [16]Bertram DA, Opila DA, Brown JL, Gallagher SJ, Schifeling RW, Snow IS, Hershey CO: Measuring physician mental workload: reliability and validity assessment of a brief instrument. Med Care 1992, 30:95-104.
• [17]Byrne AJ, Oliver M, Bodger O, Barnett WA, Williams D, Jones H, Murphy A: Novel method of measuring the mental workload of anaesthetists during clinical practice. Brit J Anaesth 2010, 105:767-771.
• [18]Holden RJ, Scanlon MC, Patel NR, Kaushal R, Escoto KH, Brown RL, Alper SJ, Arnold JM, Shalaby TM, Murkowski K, Karsh BT: A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ Qual Saf 2011, 20:15-24.
• [19]Weigl M, Müller A, Vincent C, Angerer P, Sevdalis N: The association of workflow interruptions and hospital doctors’ workload: a prospective observational study. BMJ Qual Saf 2012, 21:399-407.
• [20]Sevdalis N, Sonal A, Undre S, Vincent CA: Distractions and Interruptions in the Operating Room. In Safer Surgery: Distractions and Interruptions in the Operating Room. Edited by Flin R, Mitchell L. Farnham: Ashgate; 2009:405-419.
• [21]Tucker AL, Spear SJ: Operational failures and interruptions in hospital nursing. Health Serv Res 2006, 41:643-662.
• [22]Montgomery VL: Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit. Pediatr Crit Care Med 2007, 8:S11-S16.
• [23]Gabow PA, Karkhanis A, Knight A, Dixon P, Eisert S, Albert RK: Observations of residents’ work activities for 24 consecutive hours: implications for workflow redesign. Acad Med 2006, 81:766-775.
• [24]Grundgeiger T, Sanderson P: Interruptions in healthcare: theoretical views. Int J Med Inform 2009, 78:293-307.
• [25]Rivera-Rodriguez AJ, Karsh BT: Interruptions and distractions in healthcare: review and reappraisal. Qual Saf Health Care 2010, 19:304-312.
• [26]Li SY, Magrabi F, Coiera E: A systematic review of the psychological literature on interruption and its patient safety implications. J Am Med Inform Assoc 2012, 19:6-12.
• [27]Hart SG: Nasa-task load index (Nasa-TLX); 20 years later. Proc Hum Factors Ergon Soc Annu Meet 2006, 50:904-908.
• [28]Weigl M, Hoffmann F, Muller A, Barth N, Angerer P: Hospital paediatricians’ workflow interruptions, performance, and care quality: a unit-based controlled intervention. Eur J Pediatr 2014, 173:637-645.
• [29]Weigl M, Müller A, Zupanc A, Glaser J, Angerer P: Hospital doctors’ workflow interruptions and activities: an observation study. BMJ Qual Saf 2011, 20:491-497.
• [30]France DJ, Levin S, Hemphill R, Chen K, Rickard D, Makowski R, Jones I, Aronsky D: Emergency physicians’ behaviors and workload in the presence of an electronic whiteboard. Int J Med Inform 2005, 74:827-837.
• [31]Greiner BA, Ragland DR, Krause N, Syme SL, Fisher JM: Objective measurement of occupational stress factors-an example with San Francisco urban transit operators. J Occup Health Psychol 1997, 2:325-342.
• [32]Levin S, France DJ, Hemphill R, Jones I, Chen KY, Rickard D, Makowski R, Aronsky D: Tracking workload in the emergency department. Hum Factors 2006, 48:526-539.
• [33]Mache S, Vitzthum K, Kusma B, Nienhaus A, Klapp BF, Groneberg DA: Pediatricians’ working conditions in German hospitals: a real-time task analysis. Eur J Pediatr 2010, 169:551-555.
• [34]Brixey JJ, Robinson DJ, Turley JP, Zhang J: The roles of MDs and RNs as initiators and recipients of interruptions in workflow. Int J Med Inform 2010, 79:e109-e115.
• [35]Kreckler S, Catchpole K, Bottomley M, Handa A, McCulloch P: Interruptions during drug rounds: an observational study. Br J Nurs 2008, 17:1326-1330.
• [36]Healey AN, Sevdalis N, Vincent CA: Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics 2006, 49:589-604.
• [37]Trafton JG, Monk CA: Task interruptions. Rev Hum Factors Ergon 2007, 3:111-126.
• [38]Zijlstra FRH, Roe RA, Leonora AB, Krediet I: Temporal factors in mental work: effects of interrupted activities. J Occup Organ Psychol 1999, 72:163-185.
• [39]Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO: Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care 2004, 16:125-132.
• [40]Catchpole K, Ley E, Wiegmann D, Blaha J, Shouhed D, Gangi A, Blocker R, Karl R, Karl C, Taggart B, Starnes B, Gewertz B: A human factors subsystems approach to trauma care. JAMA Surg 2014, 149(9):962-968.
• [41]Weigl M, Hornung S, Glaser J, Angerer P: Reduction of hospital physicians’ workflow interruptions: a controlled unit-based intervention study. J Healthc Eng 2012, 3:605-620.