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Danesh V, Sasangohar F, Kallberg AS, Kean EB, Brixey JJ, Johnson KD. Systematic review of interruptions in the emergency department work environment. Int Emerg Nurs 2022; 63:101175. [PMID: 35843150 DOI: 10.1016/j.ienj.2022.101175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to describe the operationalization of interruptions measurement and to synthesize the evidence on the causes and consequences of interruptions in the emergency department (ED) work environment. METHODS This systematic review of studies explores the causes and consequences of interruptions in the ED. Of 2836 abstract/titles screened, 137 full-text articles were reviewed, and 44 articles met inclusion criteria of measuring ED interruptions. RESULTS All articles reported primary data collection, and most were cohort studies (n = 30, 68%). Conceptual or operational definitions of interruptions were included in 27 articles. Direct observation was the most common approach. In half of the studies, quantitative measures of interruptions in the ED were descriptive only, without measurements of interruptions' consequences. Twenty-two studies evaluated consequences, including workload, delays, satisfaction, and errors. Overall, relationships between ED interruptions and their causes and consequences are primarily derived from direct observation within large academic hospitals using heterogeneous definitions. Collective strengths of interruptions research in the ED include structured methods of naturalistic observation and definitions of interruptions derived from concept analysis. Limitations are conflicting and complex evaluations of consequences attributed to interruptions, including the predominance of descriptive reports characterizing interruptions without direct measurements of consequences. CONCLUSIONS The use of standardized definitions and measurements in interruptions research could contribute to measuring the impact and influence of interruptions on clinicians' productivity and efficiency as well as patients' outcomes, and thus provide a basis for intervention research.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Health, 3500 Gaston Ave, Dallas, TX 75246, United States.
| | - Farzan Sasangohar
- Applied Cognitive Ergonomics Lab Texas, A&M University, Houston, TX, United States; Industrial and Systems Engineering, Texas A&M University, 4079 Emerging Technologies Building, 3131 TAMU, College Station, TX 77843, United States.
| | - Ann-Sofie Kallberg
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Emergency Medicine, Falun Hospital, Dalarna University, SE-79188, Sweden.
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, 231 Albert Sabin Way, Cincinnati, OH 45267, United States.
| | - Juliana J Brixey
- Biomedical Informatics and Nursing, The University of Texas Health Science Center, 6901 Bertner Ave, Rm 629, Houston, TX 77030, United States.
| | - Kimberly D Johnson
- University of Cincinnati, College of Nursing, 234 Proctor Hall 3110 Vine St., Cincinnati, OH 45221, United States.
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Zoellick JC, Kuhlmey A, Schenk L, Blüher S. Method-oriented systematic review on the simple scale for acceptance measurement in advanced transport telematics. PLoS One 2021; 16:e0248107. [PMID: 33764981 PMCID: PMC7993792 DOI: 10.1371/journal.pone.0248107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Acceptance intuitively is a precondition for the adaptation and use of technology. In this systematic review, we examine academic literature on the “simple scale for acceptance measurement” provided by Van der Laan, Heino, and de Waard (1997). This measure is increasingly applied in research on mobility systems without having been thoroughly analysed. This article aims to provide such a critical analysis. We identified 437 unique references in three aggregated databases and included 128 articles (N = 6,058 participants) that empirically applied the scale in this review. The typical study focused on a mobility system using a within-subjects design in a driving simulator in Europe. Based on quality indicators of transparent study aim, group allocation procedure, variable definitions, sample characteristics, (statistical) control of confounders, reproducibility, and reporting of incomplete data and test performance, many of the 128 articles exhibited room for improvements (44% below.50; range 0 to 1). Twenty-eight studies (22%) reported reliability coefficients providing evidence that the scale and its sub-scales produce reliable results (median Cronbach’s α >.83). Missing data from the majority of studies limits this conclusion. Only 2 out of 10 factor analyses replicated the proposed two-dimensional structure questioning the use of these sub-scales. Correlation results provide evidence for convergent validity of acceptance, usefulness, and satisfying with limited confidence, since only 14 studies with a median sample size of N = 40 reported correlation coefficients. With these results, the scale might be a valuable addition for technology attitude research. Firstly, we recommend thorough testing for a better understanding of acceptance, usefulness, and satisfying. Secondly, we suggest to report scale results more transparently and rigorously to enable meta-analyses in the future. The study protocol is available at the Open Science Framework (https://osf.io/j782c/).
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Affiliation(s)
- Jan C. Zoellick
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
- * E-mail:
| | - Adelheid Kuhlmey
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Liane Schenk
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Stefan Blüher
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
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Tomasi J, Warren C, Kolodzey L, Pinkney S, Guerguerian AM, Kirsch R, Hubbert J, Sperling C, Sutton P, Laussen P, Trbovich P. Convergent parallel mixed-methods study to understand information exchange in paediatric critical care and inform the development of safety-enhancing interventions: a protocol study. BMJ Open 2018; 8:e023691. [PMID: 30173162 PMCID: PMC6120652 DOI: 10.1136/bmjopen-2018-023691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The effective exchange of clinical information is essential to high-quality patient care, especially in the critical care unit (CCU) where communication failures can have profoundly negative impacts on critically ill patients with limited physiological capacity to tolerate errors. A comprehensive systematic characterisation of information exchange within a CCU is needed to inform the development and implementation of effective, contextually appropriate interventions. The objective of this study is to characterise when, where and how healthcare providers exchange clinical information in the Department of Critical Care Medicine at The Hospital for Sick Children and explore the factors that currently facilitate or counter established best rounding practices therein. METHODS AND ANALYSIS A convergent parallel mixed-methods study design will be used to collect, analyse and interpret quantitative and qualitative data. Naturalistic observations of rounds and relevant peripheral information exchange activities will be conducted to collect time-stamped event data on workflow and communication patterns (time-motion data) and field notes. To complement observational data, the subjective perspectives of healthcare providers and patient families will be gathered through surveys and interviews. Departmental metrics will be collected to further contextualise the environment. Time-motion data will be analysed quantitatively; patterns in field note, survey and interview results will be examined based on themes identified deductively from literature and/or inductively based on the data collected (thematic analysis). The proactive triangulation of these systemic, procedural and contextual data will inform the design and implementation of efficacious interventions in future work. ETHICS AND DISSEMINATION Institutional research ethics approval has been acquired (REB #1000059173). Results will be published in peer-reviewed journals and presented at relevant conferences. Findings will be presented to stakeholders including interdisciplinary staff, departmental management and leadership and families to highlight the strengths and weaknesses of the exchange of clinical information in its current state and develop user-centred recommendations for improvement.
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Affiliation(s)
- Jessica Tomasi
- HumanEra, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Carly Warren
- HumanEra, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Kolodzey
- HumanEra, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Sonia Pinkney
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roxanne Kirsch
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jackie Hubbert
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christina Sperling
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia Sutton
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Laussen
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia Trbovich
- HumanEra, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Interruptions During Senior Nurse Handover in the Intensive Care Unit: A Quality Improvement Study. J Nurs Care Qual 2018; 34:E15-E21. [PMID: 29916941 DOI: 10.1097/ncq.0000000000000345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interruptions during handover may compromise continuity of care and patient safety. LOCAL PROBLEM Interruptions occur frequently during handovers in the intensive care unit. METHODS A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention. INTERVENTIONS The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback. RESULTS Forty handovers were audiotaped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention. CONCLUSIONS Further work is required to reduce interruptions that do not benefit patient care.
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McCurdie T, Sanderson P, Aitken LM. Traditions of research into interruptions in healthcare: A conceptual review. Int J Nurs Stud 2016; 66:23-36. [PMID: 27951432 DOI: 10.1016/j.ijnurstu.2016.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. OBJECTIVE To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. METHODS A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community's motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. RESULTS A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. CONCLUSIONS Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions.
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Affiliation(s)
- Tara McCurdie
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane 4072, Australia.
| | - Penelope Sanderson
- Schools of Information Technology and Electrical Engineering, of Psychology, and of Medicine, The University of Queensland, Brisbane, Australia
| | - Leanne M Aitken
- School of Nursing & Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Health Sciences, City University London, London, United Kingdom
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Sasangohar F, Donmez B, Easty AC, Trbovich PL. The relationship between interruption content and interrupted task severity in intensive care nursing: an observational study. Int J Nurs Stud 2015; 52:1573-81. [PMID: 26162227 DOI: 10.1016/j.ijnurstu.2015.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND In a previous study, we observed that the majority of interruptions experienced by nurses in a cardiovascular intensive care unit (CVICU) carried information directly related to their patient or other aspects of work affecting other patients or indirectly affecting their patient. Further, the proportion of interruptions with personal content was significantly higher during low-severity (in case of an error as defined by nurses) tasks compared to medium- and high-severity tasks suggesting that other personnel may have evaluated the criticality of the nurses' tasks before interrupting. However, this earlier study only collected data when an interruption happened and thus could not investigate interruption rate as a function of primary task type and severity while controlling for primary task duration as an exposure variable. OBJECTIVES We addressed this methodological limitation in a second observational study that was conducted to further study interruptions and also to evaluate an interruption mitigation tool. The data from the baseline condition (i.e., no tool) is analyzed in this paper to validate the results of our previous study and to report interruption rates observed during tasks of varying severities (low, medium, high), with a particular focus on comparing different interruption contents. DESIGN AND SETTING The study was conducted in a 24-bed closed CVICU at a Canadian hospital, during day shifts. PARTICIPANTS The baseline condition involved thirteen nurses. METHODS Over a 3-week period, three researchers observed these nurses 46-120 min each, with an average of 89 min. Data were collected in real time, using a tablet computer and software designed for this purpose. The rate of interruptions with different content was compared across varying task severity levels as defined by CVICU nurses. RESULTS Nurses spent about 50% of their time conducting medium-severity tasks (e.g., documentation), 35% conducting high-severity tasks (e.g., procedure), and 14% conducting low-severity tasks (e.g., general care). The rate of interruptions with personal content observed during low-severity tasks was 1.97 (95% confidence interval, CI: 1.04, 3.74) and 3.23 (95% CI: 1.51, 6.89) times the rate of interruptions with personal content observed during high- and medium-severity tasks, respectively. CONCLUSIONS Interrupters might have evaluated task severity before interrupting. Increasing the transparency of the nature and severity of the task being performed may help others further modulate when and how they interrupt a nurse. Overall, rather than try to eliminate all interruptions, mitigation strategies should consider the relevance of interruptions to a task or patient as well as their urgency.
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Affiliation(s)
- Farzan Sasangohar
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8; HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4
| | - Birsen Donmez
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8.
| | - Anthony C Easty
- HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, Canada M5S 3G9
| | - Patricia L Trbovich
- HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, Canada M5S 3G9
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