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The impact of interruptions on the duration of nursing interventions: a direct observation study in an academic emergency department
  1. Gai Cole1,
  2. Dicky Stefanus2,
  3. Heather Gardner3,
  4. Matthew J Levy3,
  5. Eili Y Klein3
  1. 1Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
  2. 2Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Gai Cole, Emergency Medicine, Johns Hopkins Medicine, 5801 Smith Ave, Davis Building, Suite 220, Baltimore, MD 21209, USA; gcole4{at}


Background Interruptions to nursing workload may contribute to procedural failures and clinical errors impacting quality/safety of care, but the impact of interruptions on the duration of these activities has not been closely scrutinised. This study analyses the effect of interruptions to care provided by nurses and clinical technicians on the length of clinical procedures and interventions (excluding the length of the interruption).

Methods An observational time study of the effect of interruptions on common nursing interventions in the emergency department (ED) of a large academic medical centre was conducted. This study used direct observations of nurses and clinical technicians while delivering care to patients.

Results The average time spent on an uninterrupted intervention was 296.47 s (median:185.15, SD:319.05), while interrupted interventions took 682.02 s (median:589.63, SD:504.59). Controlling for intervention type and other potential confounding factors using multiple linear regression found that interrupted interventions were 121.36 s (95% CI 79.57 to 163.15) longer, a 19 percentage point increase (95% CI 11.31 to 26.89), than an intervention without (excluding the length of the interruption). Family/patient interruptions effected duration the most while staff interruptions affected the intervention time the least.

Discussion Our findings are consistent with outcomes of studies in non-healthcare domains, but are contrary to a study of ED physicians, suggesting differential responses to interruptions by physicians and nurses. Future studies on interruptions in healthcare should thus be discipline specific. Though the effect of interruptions on intervention length is only about 2 min, in an ED setting, this can increase patient risks and costs. To better focus efforts to reduce interruptions future research should focus on further separation of interruption type (eg, urgent vs routine or unnecessary).

  • Emergency department
  • Healthcare quality improvement
  • Nurses
  • Human factors
  • Interruptions

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