title: Workflow interruptions and mental workload in hospital pediatricians: an observational study.
abstract: BACKGROUND
  Pediatricians' workload is increasingly thought to affect pediatricians' quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians' attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts.
  
  
  METHODS
  In an Academic Children's Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians' workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration.
  
  
  RESULTS
  Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload.
  
  
  CONCLUSIONS
  The findings provide insights into specific pathways between different types of interruptions and pediatricians' mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany. matthias.weigl@med.lmu.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Weigl
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Peter
authors.initials: P
authors.lastname: Angerer
authors.forename: Florian
authors.initials: F
authors.lastname: Hoffmann
mesh_terms: D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D010372:Pediatrics / Q000458:organization & administration; D011446:Prospective Studies; D013315:Stress, Psychological; D057188:Workflow