• Quality improvement
• Quality measurement
• Patient safety

We thank Pucher and Aggarwal1 for their interest in our paper and their kind words on how our research adds to the literature on this topic. We welcome the opportunity to share more detail about our study in response to their three specific questions.

The first question related to how specific distractions used in the study were chosen. These were selected after discussion with a number of local clinical colleagues, ranging from relatively junior doctors through to experienced senior consultants. The results from these focus groups indicated six common workplace distractions. These were the doctor's pager, dealing with ward telephone calls, background noise (such as the ward radio and a domestic's hoover), managing ad hoc prescription tasks and interacting with relatives. …