title: A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety.
abstract: BACKGROUND
  Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety.
  
  
  METHODS
  We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists.
  
  
  RESULTS
  Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy.
  
  
  CONCLUSIONS
  Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine.
authors.affiliation: Department of Nuclear Medicine & Ultrasound, Westmead Hospital & University of Sydney, Sydney, New South Wales, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Larcos
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Mirela
authors.initials: M
authors.lastname: Prgomet
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Johanna
authors.initials: J
authors.lastname: Westbrook
mesh_terms: D001315:Australia; D017598:Efficiency, Organizational; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D017056:Medical Laboratory Personnel / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009684:Nuclear Medicine Department, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D061214:Patient Safety; D019275:Radiopharmaceuticals; D013647:Task Performance and Analysis; D016526:Workload; D017132:Workplace / Q000458:organization & administration / Q000706:statistics & numerical data
chemical_list: D019275:Radiopharmaceuticals
keywords: Health services research; Healthcare quality improvement; Interruptions; Patient safety