Interruptions are a common occurrence in healthcare. Think about all the emergency codes that require us to drop everything, or a phone call from a colleague regarding your patient, or simply the sudden urge to use the toilet, which might require you to interrupt your work and even interrupt a colleague to cover for you as you answer nature's call. While interruptions are generally troublesome and undesirable, not all interruptions are the same and should be treated the same way. For example, safety-related interruptions like the fire alarm or someone shouting for help can be the difference of life or death if you do not respond immediately.
Yet we know all too well the inconveniences and slip-ups when our focused attention is broken by interruptions.
The perception of interruptions differs depending on whether you're the interrupter or the "interruptee." The interrupter often finds themselves in a position where work cannot proceed without seeking assistance, such as a nurse interrupting a physician to place a stat order. But this interruption may not hold the same value for the interruptee, especially when they are focused on their current task, like trying to recall and document another patient's details into the case notes.
Now, the interruptee is burdened with the responsibility of making the "right" choice: Should you risk errors in your current task by attending to the sudden request? Can you afford to make the interrupter wait? What if the interrupter is your senior, or a patient that's about to get hurt, or an anxious and irate caregiver who is unlikely to back off?
In this BMJ article
by Rivera-Rodriguez & Karsh, a comprehensive review on healthcare interruptions was performed which argued the impracticalities of eliminating interruptions entirely. So then how?
Firstly, we can rationalize the need for some interruptions. Are there routine interruptions that don't add value or increase the risk of critical processes being interrupted? How can we minimize these interruptions? A good example I've seen is implementing "toilet rounds" in the wards to allow fall-risk patients to relieve themselves before starting medication rounds.
For critical processes that don't tolerate interruptions well, we may need to invest more effort in refining and improving their efficiency. As an extreme example, spacewalks on the International Space Station are delicate and highly dangerous activities. The longer an astronaut spends in space, the greater the exposure to harm, such as missteps, accidents, or debris puncturing their suit. Officially known as an extravehicular activity (EVA), a spacewalk is a last resort after considering the use of robots. Each spacewalk is meticulously planned to be as efficient as possible: Entry and exit paths are calculated, with Plan Bs on standby. Spare parts are kept handy to reduce excessive traveling. Equipment are designed to be secured and removed with minimal bolts.
Similarly, in the case of nurses administering medication in the wards, the longer a nurse spends struggling with software interfaces or searching for missing medications, the more vulnerable the nurse is as a target for interruptions.
When you interrupt someone, know that you may be taking them away from a task that's possibly more important than yours. If you're the one being interrupted, make an effort to indicate where you left off (e.g., use a bookmark), or consider restarting the process to ensure you did not miss out any crucial steps.
Nevertheless, no strategy is perfect. Tummy aches and surprise parties and websites crashing in the middle of buying concert tickets are just some examples of unpredictable interruptions we may face everyday, and we just have to accept and deal with it as they come. Writing this commentary, which I started days ago, was periodically interrupted or forgotten as I attended to other important matter. Knowing my tendency to lose my thoughts, I scribbled down notes.
About Dr Yin Shanqing
Commonly referred to by his initials, SQ, Dr Shanqing is Assistant Director, Human Factors & Systems Design, KKH, and serves as the resident human factors specialist within SGH and KKH. For over 13 years, he has applied human factors principles and methodologies to healthcare research, innovation, and quality improvement. He welcomes anyone to consult him on problems or projects that might require human factors insights.