Learning Objective #1: Define an interruption

Learning Objective #2: List types of interruptions in this study derived through ground theory methods

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INTRODUCTION High-risk industries, such as nuclear power plants and aviation, have studied how interruptions contribute to accidents and errors. However, little is known about how interruptions affect tasks performed by nurses. For the purpose of this study, an interruption was defined as a “break in a person's performance of an activity when that break was initiated by a source internal or external to the person and resulted in the suspension of the initial task, or the performance of an unplanned task with the assumption of resuming the initial task upon completion of the new task”. The aim of this study was to identify interruptions experienced by RNs working in a Level One Trauma Center.

METHODS Study Design: A non-participatory ethnographic study. Subjects: A convenience sample of RNs with a least six months experience in the emergency department were asked to participate. Each observation session lasted a minimum of four hours but did not exceed twelve hours.

Study Protocol: Observers typically worked in teams of two recording observations using a semi-structured field note. Each time stamped observation was transcribed into an Excel spreadsheet with additional analysis performed using MacShapa.

Data Analysis: Categories for interruptions were developed using Grounded Theory. Two coders analyzed the data for agreement to determine a percent agreement score.

RESULTS Eight nurses were consented and seven were observed for a total of 35 hours. One nurse was excused from participation after a change in responsibilities. Six interruption categories were identified. One hundred eleven interruptions were identified in which the subject was the recipient of an interruption. Coder agreement was in excess of 85 %.

DISCUSSION Grounded Theory techniques were useful to identify and classify interruptions experienced by emergency nurses. Results indicate that about three interruptions occur per hour supporting the claim that healthcare is interrupt driven.