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The impact of interruptions on clinical task completion
  1. Johanna I Westbrook1,
  2. Enrico Coiera2,
  3. William T M Dunsmuir3,
  4. Bruce M Brown3,
  5. Norm Kelk4,
  6. Richard Paoloni5,
  7. Cuong Tran
  1. 1Health Informatics Research & Evaluation Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
  2. 2Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia
  3. 3School of Mathematics and Statistics, Faculty of Science, University of New South Wales, Sydney Australia
  4. 4Brain and Mind Research Institute, Faculty of Medicine, University of Sydney, Sydney Australia
  5. 5Emergency Department, Concord Repatriation General Hospital, Sydney, Australia
  1. Correspondence to Professor Johanna I Westbrook, The University of Sydney, PO Box 170, Lidcombe, Sydney 1825, Australia; Johanna.westbrook{at}


Background Interruptions and multitasking are implicated as a major cause of clinical inefficiency and error.

Objective The aim was to measure the association between emergency doctors' rates of interruption and task completion times and rates.

Methods The authors conducted a prospective observational time and motion study in the emergency department of a 400-bed teaching hospital. Forty doctors (91% of medical staff) were observed for 210.45 h on weekdays. The authors calculated the time on task (TOT); the relationship between TOT and interruptions; and the proportion of time in work task categories. Length-biased sampling was controlled for.

Results Doctors were interrupted 6.6 times/h. 11% of all tasks were interrupted, 3.3% more than once. Doctors multitasked for 12.8% of time. The mean TOT was 1:26 min. Interruptions were associated with a significant increase in TOT. However, when length-biased sampling was accounted for, interrupted tasks were unexpectedly completed in a shorter time than uninterrupted tasks. Doctors failed to return to 18.5% (95% CI 15.9% to 21.1%) of interrupted tasks.

Conclusions It appears that in busy interrupt-driven clinical environments, clinicians reduce the time they spend on clinical tasks if they experience interruptions, and may delay or fail to return to a significant portion of interrupted tasks. Task shortening may occur because interrupted tasks are truncated to ‘catch up’ for lost time, which may have significant implications for patient safety.

  • Communication
  • emergency department
  • quality of care

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  • This work was completed while NK was a Research Fellow at the Health Informatics Research and Evaluation Unit, Faculty of Health Sciences, University of Sydney, Australia.

  • Funding The study was funded by grants from the Health Contribution Fund (HCF) Health and Medical Research Foundation and the National Health and Medical Research Council (NHMRC) Program grant 568612. The funding sources had no role in the design, conduct, or reporting of this study.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the the hospital and the University of New South Wales Human Research Ethics committees.

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