Driven to distraction: The nature and apparent purpose of interruptions in critical care and implications for HIT.
To examine the apparent purpose of interruptions in a Pediatric Intensive Care Unit and opportunities to reduce their burden with informatics solutions.



In this prospective observational study, researchers shadowed clinicians in the unit for one hour at a time, recording all interruptions participating clinicians experienced or initiated, their starting time, duration, and a short description that could help to infer their apparent purpose. All captured interruptions were classified inductively on their source and apparent purpose and on the optimal representational media for fulfilling their apparent purpose.



The researchers observed thirty-four one-hour sessions with clinicians in the unit, including 21 nurses and 13 residents and house physicians. The physicians were interrupted on average 11.9 times per hour and interrupted others 8.8 times per hour. Nurses were interrupted 8.6 times per hour and interrupted others 5.1 times per hour. The apparent purpose of interruptions included Information Seeking and Sharing (n=259, 46.3%), Directives and Requests (n=70, 12%), Shared Decision-Making (n=49, 8.8%), Direct Patient Care (n=36, 6.4%), Social (n=71, 12.7%), Device Alarms (n=28, 5%), and Non-Clinical (n=10, 1.8%); 6.6% were not classified due to insufficient description. Of all captured interruptions, 29.5% were classified as being better served with informational displays or computer-mediated communication.



Deeper understanding of the purpose of interruptions in critical care can help to distinguish between interruptions that require face-to-face conversation and those that can be eliminated with informatics solutions. The proposed taxonomy of interruptions and representational analysis can be used to further advance the science of interruptions in clinical care.
Department of Biomedical Informatics, Columbia University, 622 W. 168th Street, VC-5, New York, NY 10032, United States. Electronic address: lena.mamykina@dbmi.columbia.edu.
Lena
L
Mamykina
Columbia University School of Nursing, New York-Presbyterian Hospital, 617 West 168th Street, New York, NY 10032, United States.
Eileen J
EJ
Carter
ColumbiaDoctors, Columbia University Medical Center, Faculty Practice Organization, 630 W 168th Street, New York, NY 10032, United States.
Barbara
B
Sheehan
Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 630 W 168th Street, New York, NY 10032, United States.
R
R
Stanley Hum
Department of Biomedical Informatics, Columbia University, 622 W. 168th Street, VC-5, New York, NY 10032, United States.
Bridget C
BC
Twohig
Department of Biomedical Informatics, Arizona State University, 13212 East Shea Boulevard, Scottsdale, AZ 85259, United States.
David R
DR
Kaufman
D001288:Attention; D003142:Communication; D003422:Critical Care / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007400:Interprofessional Relations; D010820:Physicians; D011446:Prospective Studies
Intensive care (E02.760.190.400); Interruptions; Observational study; Taxonomy/classification (L01.100); workflow (L01.906.893)