Table 1

Main results of the reviewed studies

AuthorSetting and subjectsDesign methodResults and comments
Alvarez and Coiera52Intensive care unit (ICU) teaching hospital; trauma centre and ICU
3 senior and 3 junior registrars, and 3 nurses
Recorded conversations with lapel microphones
345 total conversation-initiating interruptions
492 total turn-taking interruptions
Blum and Lieu7Children's hospital; teaching hospital
18 interns
Interns kept logs and recorded the pages they received235 pages interrupted patient care activities
126 pages interrupted scheduled work rounds and educational conferences
88 pages interrupted personal care activities
Brixey et al15Trauma section of the emergency department (ED) of a large teaching hospital
5 attending ED physicians and 8 nurses
Observations using a semistructured field note form on a tablet PCPhysicians experienced roughly 10 interruptions per hour
Nurses experienced approximately 12 interruptions per hour
Sources of interruptions: telephone, pager, other people, self
After being interrupted, physicians and nurses resumed their primary task only after they performed 1–8 other tasks
Chisholm et al14ED of urban teaching hospital; ED of suburban private teaching hospital; ED of rural county community hospital
30 emergency physicians (EPs)
Observations using standardised data collection form
Conducted task analysis
Mean number of interruptions: 30.9 (9.7)
Mean number of break-in-task: 20.7 (6.3)
Chisholm et al8EDs of 5 non-teaching community hospitals; 22 primary care offices
22 EPs and 22 office-based primary care physicians (PCPs)
Task analysis
EP's mean interruptions per hour (by source): total=9.7; care=5.6; patient=0.4; non-patient=2.3; telephone=1.4; break-in-task=5.4
PCPCs mean interruptions per hour (by source): total=3.9; care=1.9; patient=0.2; non-patient=1.4; telephone=0.6; break-in-task=1.8
Coiera et al53ED of rural hospital; ED of urban tertiary teaching hospital
6 nurses and 6 doctors
Recorded conversations with lapel microphones
Total interruptions: 393; nurses' interruptions: 185; doctors' interruptions: 208
Rate of interruptions for all subjects: 11.15 per hour; nurses' rate of interruptions: 11.2 per hour; doctors' rate of interruptions: 11.1 per hour
Coiera and Tombs54Teaching hospital
8 physicians from general medicine and 2 nurses from the medical ward
Recorded conversations with lapel microphones
Participants generated 43 pages and received 23 pages
Participants generated 65 phone calls and received 31 phone calls
Dearden et al20Inner city patient practice
1 general practitioner (GP) and 102 patients
Phase I: observations
Phase 2: survey
Phase I:63 interrupted consultations (interruption rate=10.2 %)
Sources and number of interruptions: phone=31; forms/prescription=24; other=8
Phase II: 65% of patients unaffected by the interruption 18% of patients had negative feelings about interruptions
Flynn et al21Pharmacy in non-government, not-for-profit general medical–surgical hospital
14 pharmacists and 10 technicians
Tested visual acuity, hearing and distractibility
Video taped
2022 interruptions were detected, affecting 1143 prescription sets.
Error rate of interrupted prescriptions sets=6.65%
2457 distractions were identified, affecting 1329 prescription sets
Error rate of distracted prescriptions sets=6.55%
France et al11Adult ED at Vanderbilt University Medical Center10 emergency medicine (EM) physicians, 5 post-graduate year-three (PGY-3) resident physicians and 5 post-graduate year-two (PGY-2) resident physiciansObservations using standardised data collection form on a handheld computer
Task analysis
NASA Task Load Index survey
2053 total tasks
333 interruptions were recorded. Of those, 93 were breaks-in-tasks and 210 were temporary interruptions
EM physicians completed 102.4 tasks and were interrupted 16.0 times per 180 min observational period
PGY-3 completed 108 tasks and were interrupted 17.6 times per 180 min observational period
PGY-2 completed 97.8 tasks and were interrupted 11.0 times per 180 min observational period
Categorisation of interruptions: face-to-face physician; face-to-face nurse; face-to-face other; lost chart, form or document; page; direct patient care; phone call; equipment malfunction; and other
Friedman et al12ED of quaternary care teaching
11 EPs
Observations using standardised data collection form400 interruptions were detected (4.4 interruptions per hour)
378 interruptions were categorised by source: nurses=53.7%; physicians=31.8%; family member=5.8%
87.5% of interruptions resulted in little movement
9.75% of interruptions resulted in more than 3 m movement
Harvey et al92 teaching hospitals
10 interns and nursing staff of 3 representing medical units
Interns kept logs and recorded the pages they received
Nursing staff kept logs and recorded pages they made to interns
Interns' recorded reasons for pages: prescribing of medication (45%), patient assessment (24%), reporting of laboratory results (17%), starting intravenous line or venipuncture (8%), death pronouncement (1%), resuscitation (1%), wrong number (1%), not recorded (4%)
19% of pages interrupted direct patient care
Healey, Primus et al33Operating theatre in teaching hospital
4 consultant urologists and their surgical teams
ObservationsMean interruption duration/case: 5.66 min
Mean interruption duration/case duration: 13.05%
Source of interruptions: conversation=198; phone=130; bleeper=26; equipment=58; procedure=36; environment=163; monitor=3
Healey, Sevdalis et al34Operating theatre in teaching hospital
Surgical team of anaesthetists, surgeons, nurses and their assistants
ObservationsMean interference per case: 50.14 min
No of distractions/interruption experienced: surgeons=276; nurses=213; anaesthetist=116
Hedberg and Larsson10Medical ward; geriatric rehabilitation ward; primary healthcare unit
6 nurses (2 from each ward/unit)
Observations85 interruptions detected
Source and number of interruptions: patient=21; family=7; assistant nurse=23; nurse=8; physician=8; secretary=7; noise=11
Nurses' activities and number of interruptions: direct patient care=53; indirect patient care=27; other=5
29% of interruptions occurred during medication administration
14% of interruptions occurred during documentation
Laxmisan et al55Adult ED within large tertiary, teaching hospital
Staff in ED
Attending physicians experienced an interruption every 9 min
Residents experienced an interruption every 14 min
Pape16Medical–surgical nursing unit in acute care hospital
Nurses: control group (n=8); focused protocol (n=8); Medsafe (n=8)
Quasi-experimental three-group design of the medication administration processControl group experienced 484 distractions
Focused protocol group experienced 180 distractions (focused vs control: p<0.001)
Medsafe protocol group experienced 64 distractions (Medsafe vs control: p<0.001; Medsafe vs focused: p<0.014)
Pape et al175 nursing units in large hospital
78 staff nurses
Observations before and after intervention
Mean distraction score before intervention: 42
Mean distraction score after intervention: 31
Pre/post results significantly different: p<0.001
Paxton et al22General practices
In 1990: 34 nurses; In 1991: 33 nurses; both years: 85 GPs and 1,930 patients
Patient and GP questionnaires
1990: nurses observed a total of 3081 interruptions
1991: nurses observed a total of 1,729 interruptions
GPs observed a total of 4,030 interruptions
4% of patients interrupted, felt it was an intrusion
Peleg et al18Urban primary clinic
2 adult family doctors
Doctors recorded interruptions experienced before and after interventionPreintervention: 528 interruptions in 379 consultations
Postintervention: 402 interruptions in 355 consultations
Pre/post decrease of 19% of interruptions (p = 0.21)
Potter et al1General acute medicine nursing unit
Dyad of 1 registered nurse (RN) and 1 patient care technician
ObservationsRN experienced 43 different interruptions classified as: delays in staring, direct disruptions, or indirect disruptions
Potter et al2Large tertiary medical centre in the Midwest
7 RNs
Observations by human factors engineer (HFE) and nurse researcher (NR)
Task analysis
Interruptions observed by HFE: 261 (mean=5.9 per h)
Interruptions observed by NR: 151 (mean=3.4 per h)
47% of interruptions occurred when nurses were performing interventions; 22% occurred during medication preparation;
Interruptions averaged 7% of nurses work time
Rhoades et al23Primary care outpatient clinics of teaching hospital
22 residents and their patients
Observations using standardised collection form
Residents interrupted patients an average of 2 times/visit
Residents using computer interrupted 66% of the visits
Knock on door interrupted 15% of the visits
Beepers interrupted 8% of the visits
Residents leaving the room interrupted 33% of the visits
Patients who felt they had not spoken enough experienced significantly more interruptions
Sevdalis et al24UK Hospital
16 surgeons, 26 nurses and 20 anaesthetists/operating departmental practitioners (OPDs)
Disruption in surgery index surveyEstimated frequency of interruptions experienced (out of 100%): surgeons=25%; nurses=42%; anaesthetist/OPDs=37%
Participants estimated that their colleagues experience more interruptions than they do (p<0.05)
Participants estimated that more disruptions contribute to errors for their colleagues than for themselves (p<0.05)
Patient-related disruptions were judged more serious to contribute to errors over other disruptions (p<0.05)
Goal of surgical procedure was judged to be obstructed by individual (p<0.01), operating room environment (p<0.05) and communication disruptions (p<0.05)
Sevdalis et al56Operating suites of a large teaching hospital
Surgical teams
Rated level of distractions
Focused on case-irrelevant communication (CIC) as distractions
167 CIC events were recorded (3.48 per operation)
26.95% CIC events were classified as irrelevant comment/query by team staff
Surgeons were most likely initiators (35.8%) and recipients (61.73%) of CIC events (p<0.05) CIC events related to equipment/provisions were considered most distracting
Shvartzman and Antonovsky574 family practice units
4 physicians
Observations136 interruptions were recorded (mean=1.36 interruptions per consultation)
Sources of interruptions (and number out of 117): nurse=51; student=41; physician=10; patient=7; maintenance worker=5; clerical worker=3
Reason for interruption (and number out of 136): sign prescription=33; obtain patient file=29; consultation=21; telephone=19; appointment diary entry=3; other=31
Spencer et al58ED of metropolitan teaching hospital
4 RNs and 4 medical officers
Recorded conversations with lapel microphones
One-third of events were considered interruptions (mean rate of 15 interruptions per person per hour)
Tucker19Nursing units in 9 hospitals
26 nurses
194 operational failures were observed (average of 1 every 74 min)
6% of failures cost hospital average of US$0.82
11% of failures cost hospital average of US$414
Tucker and Spear416 US hospitals
Phase I: 11 nurses; Phase II: 6 nurses; Phase III: 136 nurses
Phase I: observations
Phase II: interviews
Phase III: survey
Observed 8.4 operational failures per 8 h shift
Observed a total of 955 interruptions; 45 were caused by operational failures; 910 were caused by patient care considerations
Westbrook et al13Teaching hospital in Sydney
19 doctors: 7 registrars; 5 residents and 7 interns
Observations by clinically experienced RNs
Recorded data on a multidimensional work task classification system on a PDA
All doctors were interrupted 2.9 times per hour
Registrars were interrupted 2.9 times per hour
Residents were interrupted 2.5 times per hour
Interns were interrupted 3.3 times per hour
74% of interrupted tasks were resumed within the observation period (1 h)
Wiegmann et al25Operating rooms of one medical institution
Surgical teams
Observations341 disruption events were recorded (8.1 per hour; 11.0 per surgical case)
52% of the disruption events were categorised as teamwork/communication; 17% extraneous interruptions; 12% supervisory/training-related; 11% equipment/technology; and 8% resource-based
Rate of errors increased linearly with increases in the rate of disruptions (r=0.47, p<0.05)
Wolf et al59Urban, acute care hospital
7 RNs
Observations by HFE and NRObserved an average of 3.4 interruptions per hour
RNs who prepared medication following protocol were interrupted 1.3 times per hour
RNs who prepared medication violating protocol were interrupted 0.6 times per hour
Zheng et al60Surgery suites of a tertiary care hospital
Surgical teams
Video taped114 disruption events were recorded per hour
11% of the disruption events caused delays in the surgical workflow
Conversations were the largest portion of the disruption events (71 events per hour)