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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3115 — Interruptions in the ICU: A Second Look

Drews FA, VA Center for Human Factors in Patient Safety, VA Salt Lake City Medical Center, IDEAS; Markewitz B, University of Utah; Benuzillo J, VA Salt Lake Medical Center; Samore MH, VA Salt Lake Medical Center, IDEAS;

Objectives:
It is well established that task interruptions contribute to accidents in non-health care domains. Only in recent years has there been an interest in studying interruptions in health care. However, these studies provide very mixed results. The goals of this study were to identify the frequency of interruptions in the ICU and to evaluate the relationship between interruptions and patient hazards.

Methods:
A two year, observational multi-site study with trained observers collected 1148 hours of observations of nursing tasks. Trained nurse observers collected time-motion data of ICU nurses. The observers utilized mobile tablet computers that time stamped all nursing activities that were categorized as direct care (e.g. patient assessment, hygiene), indirect care (e.g. charting) or medical device use (e.g. administering medications, interacting with ventilators). Additional information recorded included the occurrence, source, length and impact of task interruptions and actual or potential medical device-related harm.

Results:
A total of 74,733 nurse activities were observed. Out of all observed activities, 9.5% were interrupted and 1.7% were associated with a patient hazard. The analysis of the impact of interruptions on patient hazards revealed a significant difference between person-caused interruptions and device-related interruptions. Interestingly, it was device related interruptions that increased the odds of a patient hazard significantly, where provider related interruptions reduced the odds significantly. Nurses used a range of strategies in dealing with interruptions, the most frequent being dual-tasking and task switching. Analysis of these response strategies indicated a significant increase in the odds of a patient hazard only when nurses responded by task switching.

Implications:
The results of this study indicate that interruptions in the ICU are frequent and have a negative impact on patient safety. However, the main contributors to the creation of hazards are device related interruptions whereas provider based interruptions reduce the likelihood of a patient hazard.

Impacts:
The results of this study indicate the need for better device integration in the ICU since it is devices interrupting nurses that created hazards. In addition, the study identified a need to train nurses in more effective interruption management strategies.


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