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The association of workflow interruptions and hospital doctors' workload: a prospective observational study
  1. M Weigl1,
  2. A Müller1,
  3. C Vincent2,
  4. P Angerer3,
  5. N Sevdalis2
  1. 1Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
  2. 2Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London, UK
  3. 3University Düsseldorf, Medical Faculty, Institute for Occupational Medicine and Social Medicine, Düsseldorf, Germany
  1. Correspondence to Dr Matthias Weigl, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, Munich D-80336, Germany; matthias.weigl{at}


Background Subjective workload in healthcare employees is suspected to be important for the performance and safety of healthcare delivery. This study investigates associations between workflow interruptions and hospital doctors' capability to manage their perceived workload in a safe and efficient manner.

Aim To examine the relationship of observed workflow interruptions with hospital doctors' perceived workload during day clinical shifts.

Methods A prospective study of 43 full shift observations with 29 doctors working in internal medicine and surgical specialties. Workflow interruptions were assessed via observation using a previously validated observation instrument. Doctors assessed their workload twice throughout their day shift using three items of the validated NASA-Task Load Index (NASA-TLX; mental demands, effort, frustration).

Results Hospital doctors were on average disrupted 3.66 times per hour. Most frequent were interruptions by nursing staff, telephone/beeper interruptions and by fellow doctors. Senior doctors reported higher workload than their junior colleagues. Overall workflow interruptions were significantly related to doctors' workload (β=0.22; p=0.03). Further analyses revealed that doctors' workload was associated particularly with interruptions by nursing personnel (β=0.23; p=0.03).

Conclusions Frequent workflow interruptions may be linked with increased workload in doctors. Healthcare environments need to be better designed to reduce unnecessary interruptions and distractions so that hospital doctors can manage clinical work efficiently and safely.

  • Workflow interruptions
  • distractions
  • hospital doctors
  • workload
  • observation
  • hospital medicine
  • human factors
  • interruptions
  • patient safety
  • fatigue
  • healthcare quality improvement
  • root cause analysis
  • risk management
  • checklists
  • cognitive biases
  • communication
  • teams

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  • Funding The study was funded by the German Medical Association (Grant No. 06-73) and Munich Center of Health Sciences. This paper was prepared during MW's stay as visiting researcher at the Imperial College London, Department for Surgery and Cancer, which was funded by a postdoctoral scholarship from the German Academic Exchange Service (Grant No. D/10/52589). CV and NS are affiliated with the Imperial Centre for Patient Safety and Service Quality, which is funded by the UK's National Institute for Health Research.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Medical Faculty, Munich University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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