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• W2915650501 abstract "The purpose of this program of research was to seek robust evidence of a causal relationship between workplace interruptions and medical errors in healthcare. Interruptions are a cause for concern in healthcare because of their association with increased workload and performance decrements. However, interruptions can be crucial to effective work coordination through means of information transfer, relationship development, and improved organizational resilience. An association exists between workplace interruptions and medical errors, but currently there is no concrete evidence that interruptions actually cause errors. Determining whether more workplace interruptions cause (or do not cause) more medical errors will provide a better evidence base for healthcare workers when designing interventions and policy to improve patient safety. In this thesis, I aimed to fill this gap in knowledge with a major prospective controlled-trial in an Intensive Care Unit (ICU) simulator.In the first phase, I reviewed and evaluated the literature on the relationship between interruptions and errors in healthcare. In the second phase, I designed the high-level components of a high-fidelity simulation study to seek evidence of a potential causal relationship between interruptions and errors. In the simulation, ICU nurses would prepare and administer intravenous medications for a simulated patient manikin and receive either 3 or 12 work-related interruptions. However, several constraints and barriers arose during the planning of the simulationmthe main issue being that I needed to conduct a statistical power analysis to estimate the required sample size, but I did not want to reduce the pool of potential participants for the main study. I thus decided to move to the laboratory for piloting and explorations in a non-healthcare setting.In the third phase, I created an analogous laboratory simulation study to the healthcare simulation study, by finding a non-healthcare task that shared similar high-level properties to medication preparation and administration, and was carried out by specialized professionals. I then mapped the abstract properties of the healthcare study scenarios to the laboratory study scenarios so that I could generalize findings from the latter to the former. The task chosen for the laboratory study was cocktail making, because it shares similar cognitive-perceptual properties to medication preparation and administration and is performed by professionals (bartenders).In the fourth phase, I conducted a zero-interruptions baseline study to determine the required sample size for the main bartending study. Ten bartenders prepared beverages in a simulated cocktail bar, and worked alongside a confederate actor who played a front of house worker. Cocktail error data were then integrated with observational data from the literature to estimate a cocktail error rate for participants who would receive a lower versus higher numberof interruptions in the second bartending study. This data was then used to estimate the required sample size for the second bartending study, which was 36 participants (18 per condition).In the fifth phase, I conducted the second bartending study, which was a controlled trial in which 36 bartenders received either 3 or 12 scenario-relevant interruptions. The method was identical to the first bartending study, except the front of house worker now delivered scenario- relevant interruptions. Bartenders who received a higher number of interruptions committed significantly more cocktail errors than bartenders who received a lower number of interruptions. The cocktail error data were then used to estimate the required sample size for the healthcare study, which was 66 participants (33 per condition).In the sixth and final phase, I finalized the design and carried out the healthcare simulation study. Seventy ICU nurses received either 3 or 12 scenario-relevant interruptions while preparing and administering medications. The interruptions were delivered by a confederate acting as a nursing team leader, the patient, the bedside phone, and equipment alarms. Nurses who received a higher number of interruptions committed significantly more clinical errors and procedural failures than nurses who received a lower number of interruptions.The healthcare study revealed that more interruptions to nurses lead to more clinical errors and procedural failuresma finding that was often assumed but had not been directly tested. This finding may place healthcare workers in a better position to design interventions and policy to improve patient safety in critical care. However, reducing the frequency of all interruptions is not recommended because many interruptions are important to the work system. Instead, it may be beneficial to balance the reduction of unnecessary interruptions with the preservation of necessary interruptions while improving their safety (for example, by increasing nursesr resilience to interruptions).The bartending study also provided evidence of a causal relationship between interruptions and errors in a non-healthcare domain, which may generalize to other hands-on work environments. Additionally, the laboratory work provided a unique method for conducting power analyses that researchers could adopt if they encounter barriers when designing field research." @default.
• W2915650501 created "2019-03-02" @default.
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• W2915650501 date "2018-07-11" @default.
• W2915650501 modified "2023-09-27" @default.
• W2915650501 title "Interruptions and errors in healthcare: seeking a causal connection" @default.
• W2915650501 doi "https://doi.org/10.14264/uql.2018.447" @default.
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