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Differentiating between detrimental and beneficial interruptions: a mixed-methods study
  1. Robert A Myers1,
  2. Mary C McCarthy2,3,
  3. Amelia Whitlatch3,
  4. Pratik J Parikh1,2
  1. 1Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, Ohio, USA
  2. 2Department of Surgery, Wright State University, Dayton, Ohio, USA
  3. 3Miami Valley Hospital, Dayton, Ohio, USA
  1. Correspondence to Dr Pratik J Parikh, Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, 207 Russ Engineering Center, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA; pratik.parikh{at}


Introduction Efforts to understand interruptions now span much of the last decade and a half. Often thought to negatively impact patient safety, some now acknowledge that interruptions may be beneficial and actually necessary for safety and high quality care. This study seeks a framework for differentiating between interruptions that are detrimental and those that are beneficial.

Methods A mixed-methods approach at a US Level 1 trauma centre included direct observation of 13 registered nurses (RNs), survey of 47 RNs, retrospective observation of hands-free communication devices, and modelling of observed interruptions to key performance measures.

Results On average, RNs were interrupted every 11 min, with 20.3% of their workload triggered by interruptions. While 85% of RNs agreed that interruptions place their patients at risk, only 21% agreed that all should be eliminated. During one 90-min period, 18 original events spawned 68 interruptions, 50 of these repeat messages. A statistical model, with patient measures of time and comfort, revealed that alarms and call lights returning RN's attention to the patient outside the patient room are beneficial, while interruptions in the patient room are generally detrimental. Triangulating the results, we present an emerging framework for differentiating between beneficial and detrimental interruptions based on the impact of interruptions on the RN's steady treatment and attention to the patient.

Conclusions A mixed-methods approach can help distinguish between detrimental and beneficial interruptions. While interruptions breaking the delivery of steady treatment and attention to the patient are detrimental, those returning the RN's focus to the patient, as well as those supporting patient-clinician and clinician-clinician communications are beneficial. This insight may be helpful to healthcare delivery teams tasked with improving interruption-laden processes.

  • Interruptions
  • Patient-centred care
  • Nurses
  • Quality measurement
  • Lean management

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  • Twitter Follow Robert Myers at @fixineer

  • Contributors RAM: Study design, literature review, data collection, modelling and analysis, and manuscript preparation. MCM: Study design, provided clinical access, process insights, manuscript editing. AW: Provided insight from RNs’ perspective during interpretation of data and manuscript editing. PJP: Study design, interpretation of statistical analysis, and manuscript preparation and editing.

  • Competing interests None declared.

  • Ethics approval Wright State University IRB, in conjunction with Miami Valley Hospital's Human Investigation and Research Committee.

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