Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses^*

* The study was submitted to the Ethical Committee of the Tuscany Region Department of Health on 24th March 2015. The Ethical Committee answered that this type of study does not fall within its scope, given that it does not affect patient care and that the observers involved in data collection belong to the GRC centre that is the public authority for patient safety with full access to the field. The research protocol has been shared with the director of the hospital, nurse and medical director of the surgical unit, the health care workers were officially informed and signed an informed consent before being observed.

Abstract

The aim of this study was to obtain baseline data on doctors’ and nurses’ work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84–35.17%) more than nurses (15.23%, 95% CI 14.24–16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95–39.60% for doctors, 27.22%, 95% CI 25.18–29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors’ time and nearly half of nurses’ time. Further investigation is needed on strategies to manage job demands and professional communications.

Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

Keywords:

• Multitasking and interruptions
• doctors’ and nurses’ workload
• safety in surgery
• structured observations

Acknowledgements

The research was co-funded by the National Institute for Insurance against Accidents at Work (INAIL), Tuscany Region, Italy and the Center for Patient Safety and Clinical Risk Management (GRC), Tuscany Region, Italy. The Centre for Health Systems and Safety Research, Australian Institute of Health Innovation at Macquarie University provided the tool and the on-line platform for data collection. The authors wish to thank the front-line workers at the 6 units who agreed to participate in the study, as well as the hospital managers who helped to organise access to the field for data collection.

Notes

* The study was submitted to the Ethical Committee of the Tuscany Region Department of Health on 24th March 2015. The Ethical Committee answered that this type of study does not fall within its scope, given that it does not affect patient care and that the observers involved in data collection belong to the GRC centre that is the public authority for patient safety with full access to the field. The research protocol has been shared with the director of the hospital, nurse and medical director of the surgical unit, the health care workers were officially informed and signed an informed consent before being observed.