I wrote recently about a fascinating study examining the impact arguments have on the performance of medical staff.  The general gist was that disagreements distract the minds of the doctors and nurses, which results in lower performance levels for the rest of the day.

Of course, the cognitive cost of distractions at work are well known, and many an article has examined the impact of open plan offices on employee productivity.  A recent paper set out to explore whether similar costs are incurred by nurses working in the Intensive Care Unit (ICU).

ICU is undoubtedly one of the most challenging environments in healthcare, with nurses performing a range of critical tasks to ensure their patients are safe.  The nature of the environment means however that they are also frequently interrupted, with the study suggesting a norm is 15 interruptions per hour.

Multilevel interruptions

The impact of a single interruption has been well documented, but what’s the impact of interruption upon interruption, both on the performance of the nurse and the wellbeing of the patient?

“During observational studies in an ICU, we noticed nurses often having to switch tasks due to interruptions, and then being asked to perform additional tasks that were also interrupted while away from their original interrupted task, a phenomenon we refer to as ‘nested interruptions.’ Some of these tasks, including ones of high severity, were not resumed after the interruptions ended,” the authors say.

To test the implications of this, the team tracked a group of ICU nurses who were performing a computerized medication data-entry task in a lab environment.  First of all, the nurses performed the task without any interruptions, then with a number of serial interruptions, and finally with a group of nested interruptions, such as those experienced on the ward.

When the results were analyzed, it emerged that it took significantly longer for nurses to resume their original task after a nested interruption, but their performance levels also dropped.  The researchers believe this form of interruption can result in an overload of our short-term memory, and thus push out of our brain information that’s key to the completion of tasks that have been interrupted.

“Hospital environments are becoming increasingly complex,” they say. “This can cause health-care personnel to experience a heavy workload and numerous interruptions, many of which are unnecessary and can be delayed. It’s essential to appropriately time interruptions in order to better ensure patient safety.”