title: Hospital paediatricians' workflow interruptions, performance, and care quality: a unit-based controlled intervention.
abstract: OBJECTIVE
  Frequent workflow interruptions jeopardise clinicians' efficiency and quality of clinical care. We sought to determine the effect of a documentation-assistant intervention. Our hypothesis was that the expected decrease of workflow interruptions enhances paediatricians' performance and simultaneously improves patients' perceived quality of care.
  
  
  METHODS
  This was a controlled intervention study with data collected before and after the intervention at a University Children's Hospital. For the intervention, a documentation assistant was assigned to an inpatient ward. The main outcome measures were workflow interruptions, paediatricians' performance, as well as patients' perceived quality of care. Workflow interruptions were assessed via standardised expert observations. Paediatricians' evaluated their performance in terms of productivity, quality, and efficiency. Additionally, standardised patients' reports on perceived quality of care were collected.
  
  
  RESULTS
  For paediatricians in the intervention ward, workflow interruptions decreased significantly from 5.2 to 3.1 disruption events per working hour (decrease in the control unit was from 3.8 to 3.1). Furthermore, paediatricians reported at follow-up significantly enhanced productivity, quality, and efficiency. Similarly, patients' ratings of care quality improved significantly over time. In multivariate analyses, we found substantial changes attributable to the intervention: for all three outcomes, we found a significant interaction effect of the intervention over study time.
  
  
  CONCLUSIONS
  The intervention streamlined paediatricians' workflow, improved day-to-day functioning of the ward, and enhanced organisational efficiency and delivery of paediatric care. Future studies should investigate potential influences between the reduction of workflow interruptions, paediatricians' perceived performance, and patient-related outcomes in quality and efficiency of paediatric care.
authors: Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University, Munich, Germany, matthias.weigl@med.lmu.de.
authors: Matthias
authors: M
authors: Weigl
authors: Florian
authors: F
authors: Hoffmann
authors: Andreas
authors: A
authors: Müller
authors: Nina
authors: N
authors: Barth
authors: Peter
authors: P
authors: Angerer
mesh_terms: D002983:Clinical Competence; D004282:Documentation; D004526:Efficiency; D005260:Female; D005858:Germany; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011787:Quality of Health Care; D016526:Workload