title: The relationship between interruption content and interrupted task severity in intensive care nursing: an observational study.
abstract: BACKGROUND
  In a previous study, we observed that the majority of interruptions experienced by nurses in a cardiovascular intensive care unit (CVICU) carried information directly related to their patient or other aspects of work affecting other patients or indirectly affecting their patient. Further, the proportion of interruptions with personal content was significantly higher during low-severity (in case of an error as defined by nurses) tasks compared to medium- and high-severity tasks suggesting that other personnel may have evaluated the criticality of the nurses' tasks before interrupting. However, this earlier study only collected data when an interruption happened and thus could not investigate interruption rate as a function of primary task type and severity while controlling for primary task duration as an exposure variable.
  
  
  OBJECTIVE
  We addressed this methodological limitation in a second observational study that was conducted to further study interruptions and also to evaluate an interruption mitigation tool. The data from the baseline condition (i.e., no tool) is analyzed in this paper to validate the results of our previous study and to report interruption rates observed during tasks of varying severities (low, medium, high), with a particular focus on comparing different interruption contents.
  
  
  METHODS
  The study was conducted in a 24-bed closed CVICU at a Canadian hospital, during day shifts.
  
  
  METHODS
  The baseline condition involved thirteen nurses.
  
  
  METHODS
  Over a 3-week period, three researchers observed these nurses 46-120 min each, with an average of 89 min. Data were collected in real time, using a tablet computer and software designed for this purpose. The rate of interruptions with different content was compared across varying task severity levels as defined by CVICU nurses.
  
  
  RESULTS
  Nurses spent about 50% of their time conducting medium-severity tasks (e.g., documentation), 35% conducting high-severity tasks (e.g., procedure), and 14% conducting low-severity tasks (e.g., general care). The rate of interruptions with personal content observed during low-severity tasks was 1.97 (95% confidence interval, CI: 1.04, 3.74) and 3.23 (95% CI: 1.51, 6.89) times the rate of interruptions with personal content observed during high- and medium-severity tasks, respectively.
  
  
  CONCLUSIONS
  Interrupters might have evaluated task severity before interrupting. Increasing the transparency of the nature and severity of the task being performed may help others further modulate when and how they interrupt a nurse. Overall, rather than try to eliminate all interruptions, mitigation strategies should consider the relevance of interruptions to a task or patient as well as their urgency.
authors.affiliation: Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8; HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: Farzan
authors.initials: F
authors.lastname: Sasangohar
authors.affiliation: Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8. Electronic address: donmez@mie.utoronto.ca.
authors.forename: Birsen
authors.initials: B
authors.lastname: Donmez
authors.affiliation: HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, Canada M5S 3G9.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Easty
authors.affiliation: HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, Canada M5S 3G9.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Trbovich
mesh_terms: D064648:Critical Care Nursing; D009741:Nursing Staff, Hospital; D013647:Task Performance and Analysis
keywords: Cardiovascular; Intensive care units; Interruptions; Nursing; Task severity