title: The association of workflow interruptions and hospital doctors' workload: a prospective observational study.
abstract: BACKGROUND
  Subjective workload in healthcare employees is suspected to be important for the performance and safety of healthcare delivery. This study investigates associations between workflow interruptions and hospital doctors' capability to manage their perceived workload in a safe and efficient manner.
  
  
  OBJECTIVE
  To examine the relationship of observed workflow interruptions with hospital doctors' perceived workload during day clinical shifts.
  
  
  METHODS
  A prospective study of 43 full shift observations with 29 doctors working in internal medicine and surgical specialties. Workflow interruptions were assessed via observation using a previously validated observation instrument. Doctors assessed their workload twice throughout their day shift using three items of the validated NASA-Task Load Index (NASA-TLX; mental demands, effort, frustration).
  
  
  RESULTS
  Hospital doctors were on average disrupted 3.66 times per hour. Most frequent were interruptions by nursing staff, telephone/beeper interruptions and by fellow doctors. Senior doctors reported higher workload than their junior colleagues. Overall workflow interruptions were significantly related to doctors' workload (β = 0.22; p = 0.03). Further analyses revealed that doctors' workload was associated particularly with interruptions by nursing personnel (β = 0.23; p = 0.03).
  
  
  CONCLUSIONS
  Frequent workflow interruptions may be linked with increased workload in doctors. Healthcare environments need to be better designed to reduce unnecessary interruptions and distractions so that hospital doctors can manage clinical work efficiently and safely.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. matthias.weigl@med.lmu.de
authors.forename: M
authors.initials: M
authors.lastname: Weigl
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.forename: C
authors.initials: C
authors.lastname: Vincent
authors.forename: P
authors.initials: P
authors.lastname: Angerer
authors.forename: N
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D000328:Adult; D017598:Efficiency, Organizational; D005260:Female; D005858:Germany; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration; D057566:Self Report; D013043:Specialties, Surgical / Q000706:statistics & numerical data; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D057188:Workflow; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data