Abstract
BackgroundInterruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task.MethodsTwenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access.ResultsRepeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03).ConclusionsInterruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.
Highlights
Interruptions are common in the healthcare setting
Our study identified that performance scores do not differ between groups, interruptions during the experimental condition resulted in a number of serious procedural errors that were not observed in the control group
Our participants reported employing multiple strategies to manage the impact of interruptions, our results suggest that these strategies may be ineffective at preventing the negative consequences of interruptions
Summary
Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task. In an observational study of an intensive care unit, interruptions of healthcare professionals occurred at a rate of 14 times per hour [1], while physicians and nurses in the emergency room setting in a trauma center were observed to be interrupted more than ten times per hour [2]. With over 5600 hospitals in the USA [15], interruptions are estimated to contribute to costs of over US$280 million per year. In the USA, an estimated 20.1 million central-line days per year occur on inpatient
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