An alarmingly large number of fatalities (more than250,000) in the United States are attributed to preventablemedical errors (Hayward & Hofer, 2001) making itthe third largest cause of death in the United States afterheart disease and cancer (Makary & Daniel, 2016). Recentstudies show a strong association between the rateof the errors made and interruptions to personnel(Spooner, Corley, Chaboyer, Hammond, & Fraser,2015). While interruptions are inherent characteristics ofthe healthcare system due to the importance of communicationto convey task-relevant information routinely(Berg et al., 2013), these interruptions are frequent andmay negatively affect patient safety (Yngman-Uhlin,Klingvall, Wilhelmsson & Jangland, 2016). For instance,interruptions affect working memory and result in shiftingfocus away from the task-at-hand and therefore maylead to a significant increase in task completion time(Elganzouri, Standish, & Androwich, 2009). Additionally,in many studies, decreased work satisfaction whichdeteriorates employee’s productivity is related to interruptions.However, observational studies indicate thatnot all interruptions are detrimental, for they may carrycrucial patient-related or task-related information that isof importance to patient safety (Sasangohar, Donmez,Easty, Storey, & Trbovich, 2012. Hence, blocking allinterruptions may not be a systematic approach to dealwith this phenomenon (Rivera-Rodriguez & Karsh,2010). Although a variety of interventions have beenintroduced to the healthcare system, these interventionswere rarely used in a sustainable manner in hospitals.This can be a result of the gaps and limitations in thestudies in this domain. While interruptions to nurseshave been studied, comprehensive investigation of interruptions’content, context, and characteristics in the ICU– one of the most complex healthcare systems – needsfurther attention (Rivera, 2014). A scoping review ofliterature was conducted to understand current models,gaps and biases in this area of research. Our findingssuggest that there are four main research gaps in existingstudies in this area which have to be focused on more infuture. These gaps are: 1) Lack of evidence connectinginterruptions to high-severity medical errors: while severalobservational studies have been conducted in ICUand other complex healthcare settings, the effects of interruptionshave been mostly studied in the context oftask resumption performance and not their direct and indirect effects on medical errors (e.g., Bower, Coad,Manning, & Pengelly, 2018). Such lack of evidence canbe attributed to two factors: cultural sensitivity and limitationsin detecting errors (Ünal & Seren, 2016); 2) Lackof using interrupters as unit of analysis: Most previousinvestigations or observes use interruptee (i.e., the nursebeing interrupted) as the unit of analysis. While understandingthe interuptee’s tasks, performance and responsebehavior is critical, understanding interrupters’intentions, available information (e.g., interuptee’s taskat-hand or interruptability), and decision mechanismsremain as important for a systematic investigation ofcontext; 3) Inconsistent accumulation of knowledge: Animportant challenge that affect the quality of knowledgein the interruptions science is the lack of consistency inmethodologies, models, definitions, and framings usedin the literature. While this issue has been raised by severalauthors (e.g., Grundgeiger & Sanderson, 2009) thiscurrent effort shows that comparison among recent studiesis still not easy, and in some cases, almost impossible;4) Study design limitations and biases: This andother reviews of interruptions research suggest the dominanceof observations as the methodology of choice.While observational studies are powerful method of understandingsystems, such studies remain among themost abused methodologies specifically in human factorsresearch.
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