• Beatrice J Kalisch and Michelle Aebersold.
• University of Michigan, Ann Arbor, Michigan, USA. bkalisch@umich.edu
• Jt Comm J Qual Patient Saf. 2010 Mar 1;36(3):126-32.

BackgroundThe environment surrounding registered nurses (RNs) has been described as fast-paced and unpredictable, and nurses' cognitive load as exceptionally heavy. Studies of interruptions and multitasking in health care are limited, and most have focused on physicians. The extent and type of interruptions and multitasking of nurses, as well as patient errors, were studied using a natural-setting observational field design. The study was conducted in seven patient care units in two Midwestern hospitals--an academic medical center and a community-based teaching hospital.MethodsA total of 35 nurses were observed for four-hour periods of time by experienced clinical nurses, who underwent training until they reached an interrater reliability of 0.90.FindingsIn the 36 RN observations (total, 136 hours) 3,441 events were captured. There were a total of 1,354 interruptions, 46 hours of multitasking, and 200 errors. Nurses were interrupted 10 times per hour, or 1 interruption per 6 minutes. However, RNs in one of the hospitals had significantly more interruptions--1 interruption every 4 1/2 minutes in Hospital 1 (versus 1 every 13.3 minutes in Hospital 2). Nurses were observed to be multitasking 34% of the time (range, 23%- 41%). Overall, the error rate was 1.5 per hour (1.02 per hour in Hospital 1 and 1.89 per hour in Hospital 2). Although there was no significant relationship between interruptions, multitasking, and patient errors, the results of this study show that nurses' work environment is complex and error prone.DiscussionRNs observed in both hospitals and on all patient care units experienced a high level of discontinuity in the execution of their work. Although nurses manage interruptions and multitasking well, the potential for errors is present, and strategies to decrease interruptions are needed.

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