Traditions of research into interruptions in healthcare: A conceptual review

Background Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. Objective To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. Methods A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community’s motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. Results A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. Conclusions Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions

Non-technical Skills in Healthcare

AbstractNon-technical Skills (NTS) are a set of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Typical NTS training topics include performance shaping factors, planning and preparation for complex tasks, situation awareness, perception of risk, decision-making, communication, teamwork and leadership. This chapter provides a framework for understanding these skills in theory and practice, how they interact, and how they have been applied in healthcare, as well as avenues for future research

Do bedside handovers reduce handover duration? : an observational study with implications for evidence-based practice

Introduction: Bedside handover is increasingly used and studied in nursing due to the method's acclaimed positive effects on patient safety, patient participation, communication, and efficiency. Still, reported results about its impact on handover duration are ambiguous. Revealing the root cause of these ambiguous effects is important, as increased duration could lead to overtime, lower job satisfaction, and failure in implementation. In contrast, decreased handover duration could lead to more efficient nursing care and facilitate implementation. Aim: To explore the effects of bedside handovers on the handover duration by comparing wards before and after the implementation of bedside handovers. Methods: As part of a multicentered longitudinal study, observations (N = 638) with time measurement were performed. Approximately 22% of the observations were performed by two researchers to check reliability. These time measurements were compared to the handover duration before the implementation of bedside handover, determined through interviews (n = 105), unstructured observations (n = 40), and a review of time schedules (n = 12). A descriptive, comparative research design was used. Results: On average, a bedside handover takes 146 s for one patient (83 s-204 s). Depending on the previously used handover model, the number of patients allocated to each nurse, and the use of a structured handover content, time gain or loss as a result of introducing the bedside handover can be expected. Linking Evidence to Action: The effect on time depends on the organizational changes necessary for the implementation of bedside handovers, most importantly the use of a decentralized handover model and structured handover content. Implementing bedside handover will therefore not always lead to a decrease in time use. A matrix for estimating the effects of bedside handover on time use is presented. While using bedside handovers will not always lead to decreased handover time, it will increase direct patient contact, increasing the possibilities for patient participation and enhancing patient safety