title: The impact of interruptions on clinical task completion.
abstract: 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.
authors.affiliation: The University of Sydney, PO Box 170, Lidcombe, Sydney 1825, Australia. Johanna.westbrook@sydney.edu.au
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
authors.forename: Enrico
authors.initials: E
authors.lastname: Coiera
authors.forename: William T M
authors.initials: WT
authors.lastname: Dunsmuir
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Brown
authors.forename: Norm
authors.initials: N
authors.lastname: Kelk
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.forename: Cuong
authors.initials: C
authors.lastname: Tran
mesh_terms: D000328:Adult; D001315:Australia; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010820:Physicians / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013647:Task Performance and Analysis; D013996:Time and Motion Studies