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MU researcher studies impact of interruptions on nurses’ work

Kim looks over Guo's shoulder as Guo pours over data on a computer.

Jung Hyup Kim (rear), an assistant professor of Industrial and Manufacturing Systems Engineering at the University of Missouri, and his team of students — including Ph.D. student Wenbin Guo, recently traveled to the Mayo Clinic in Rochester, Minn., to study just how these kinds of brief interruptions affected nurses in their emergency department. Photo by Amy Parris.

Think about how many times a person is interrupted during their workday. Someone asks a question, a phone call comes during another task, colleagues stop for a brief chat. We don’t often think about how much those brief interruptions can lead to a heavier, less-efficient workload and increased chance of errors — errors that could have hefty consequences for those working in the medical field.

While we may not think about it much, Jung Hyup Kim does.

Kim, an assistant professor of Industrial and Manufacturing Systems Engineering at the University of Missouri, and his team of students recently traveled to the Mayo Clinic in Rochester, Minn., to study just how these kinds of brief interruptions affected nurses in their emergency department. Their findings were published in “The Impact of Interrupting Nurses on Mental Workload in Emergency Departments” in the March edition of the International Journal of Human-Computer Interaction.

The key finding of the study is that interruptions occurring during two key tasks — Electronic Medical Record (EMR) documentation and direct patient care — caused the highest workload increases and thus carry the highest risk of causing errors.

“Based on our analysis, we figured out if ED (emergency department) nurses were interrupted in patient care activities, their workload was about two times higher,” Kim explained. “With EMR documentation … the workload was about four times higher than in a non-interruption scenario.”

The goal is to give nurses across the country the best information possible in order to decide which interruptions are fine and which can wait for later. And, eventually, the goal is to improve efficiency and productivity. Kim hopes to pair this study with his previous study into tracking the workflow of nurses in an Intensive Care Unit to give a clearer picture of nurse workflow.

The time and motion study was completed over the course of a week, during which time Kim and his team observed a group of experienced nurses and studied their tasks. After noting the ED nurses’ most frequent tasks, they broke them down into eight basic categories:

  • Direct care — direct interactions with patients and caregiving activities
  • Indirect care — things such as moving necessary equipment, reviewing test results, planning care, etc.
  • Documentation — Charting using EMR
  • Professional communication — discussing patient-related items with other health professionals
  • Working outside ED — Attending to any emergencies or work-related tasks outside of the department
  • In transit — movement between a patient room and nurses station
  • Social — All non-work communication, such as meals, breaks, personal calls, etc.
  • Other — Any other tasks, including supervision, education and more

They also noted the five most common interruptions to the nurses’ work:

  • Interruption by phone call
  • Interruption by colleagues
  • Interruption by residents
  • Interruption by doctor
  • Interruption by relative of patient

Kim and his team then used this information to create two simulation models — one to illustrate how the workflow worked without interruption and another to illustrate the potential effects of these interruptions on each given task. They utilized the model to reach the conclusions regarding the higher workloads after interruptions during EMR documentation and patient care.

“Our study showed that ED nurses have to be trained to avoid answering questions or non-emergency phone calls during patient care activities and EMR documentation,” Kim said.

That’s not to say all interruptions are necessarily bad. Some add very little additional work to a given task, so answering a stray question or taking a phone call isn’t an issue. And sometimes, interruptions are helpful because they point out an error and allow for a correction.

“To understand pros and cons of interruptions, ED nurses need to be aware of how the different types of interruptions influence their workload and productivity during clinical activities.” Kim said.

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