title: Interruptions in the wild: Development of a sociotechnical systems model of interruptions in the emergency department through a systematic review.
abstract: Interruptions are unavoidable in the "interrupt driven" Emergency Department (ED). A critical review and synthesis of the literature on interruptions in the ED can offer insight into the nature of interruptions in complex real-world environments. Fifteen empirical articles on interruptions in the ED were identified through database searches. Articles were reviewed, critiqued, and synthesized. There was little agreement and several gaps in conceptualizing sociotechnical system factors, process characteristics, and interruption outcomes. While multiple outcomes of interruptions were mentioned, few were measured, and the relationship between multiple outcomes was rarely assessed. Synthesizing the literature and drawing on ergonomic concepts, we present a sociotechnical model of interruptions in complex settings that motivates new directions in research and design. The model conceptualizes interruptions as a process, not a single event, that occurs within and is shaped by an interacting socio-technical system and that results in a variety of interrelated outcomes.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Center for Innovative Care in Aging, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD 21224, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Werner
authors.affiliation: Department of BioHealth Informatics, Center for Health Informatics Research & Innovation (CHIRI), Indiana University School of Informatics and Computing, Indiana University - Purdue University, Indianapolis, USA. Electronic address: rjholden@iupui.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D012963:Sociometric Techniques; D013647:Task Performance and Analysis; D016526:Workload
keywords: Emergency medicine; Interruptions; Sociotechnical systems