Interruptive communication patterns in the intensive care unit ward round

https://doi.org/10.1016/j.ijmedinf.2005.03.017Get rights and content

Summary

Objective:

An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit (ICU) during ward rounds.

Methods:

The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 h, using the communication observation method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded.

Results:

Participants averaged 75% [95% confidence interval 72.8–77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95% CI 33.9–40.1] of total communication event time (5 h: 53 min). T.T.I. accounted for 5.3% of total communication event time (56 min).

Conclusion:

This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.

Introduction

Several studies have highlighted that poor communication between healthcare workers contributes significantly as a latent source of medical error [1], [2], [3]. Furthermore, evidence exists that patients have better outcomes when nurses and doctors communicate effectively [4], [5], [6]. Past research has illustrated that interruptive communication seems to dominate in high stress medical environments. Chisholm et al. studied emergency department physicians and showed that per 180-min observation, there were a mean of 30.9 ± 9.7 interruptions [7]. An Australian study showed that doctors and nurses spent 80% of their time communicating and that 30% was considered interruptive [8].

The intensive care unit (ICU) is an area of the hospital where the sickest patients reside. Poor communication is perceived as a significant root cause of error in ICU [9], [10]. However, little observational data regarding communication in the ICU exists. This study explores the patterns of communication between healthcare workers during intensive care ward rounds and focuses on interruptions, which may disrupt working memory and as a consequence cause clinical errors [30].

Section snippets

Method

The study was conducted at the intensive care unit of a large metropolitan teaching hospital located in Sydney, NSW, Australia. The hospital is a trauma center with over 500 hospital beds and 12 intensive care beds (ICU). All observations occurred during the daily morning or evening ward rounds. This is typically the busiest times of the day when all patients are examined and many management decisions are made. The observations occurred between June 2002 and February 2003. Prior to recruitment

Results

Subjects were observed for a total of twenty-four hours, and communication events accounted for 17.5 h of the total time observed.

Discussion

To our knowledge, no previous study has examined the communication patterns of the intensive care ward round, nor analysed for turn-taking interruptions. Our results support previous findings of high interruptive communication patterns in the clinical domain. Over a third of communication events in this study were classified as communication-initiating interruptions, similar to the 30.6% interruption rate reported in a previous study of two Australian emergency departments [8]. A separate study

Conclusion

These results suggest that intensive care personnel spend the majority of their time in the ward round communicating and that interruptions are prevalent. Turn-taking interruptions are well documented in other arenas, but this study highlights that they are a significant and previously unanticipated additional source of disruption to clinical activity. Clearly some types of interruption are necessary, and further research is required to understand the specific consequences of different

References (34)

  • C.D. Chisholm et al.

    Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”?

    Acad. Emerg. Med.

    (2000)
  • E.W. Coiera et al.

    Communication loads on clinical staff in the emergency department

    Med. J. Aust.

    (2002)
  • N.S. Abramson et al.

    Adverse occurrences in intensive care units

    JAMA

    (1980)
  • Y. Donchin et al.

    A look into the nature and causes of human errors in the intensive care unit

    Crit. Care Med.

    (1995)
  • R. Spencer et al.

    Communication Observation Method (COM) Manual

    (2002)
  • T.R. Gadacz

    A changing culture in interpersonal and communication skills

    Am. Surg.

    (2003)
  • G.B. Clack

    Medical graduates evaluate the effectiveness of their education

    Med. Educ.

    (1994)
  • Cited by (129)

    • Examining Interruptions in the Operating Room Using Simulation

      2018, Clinical Simulation in Nursing
      Citation Excerpt :

      Early studies about interruptions in health care were conducted outside the surgery setting. For example, an early study reported by Alvarez (2005) was conducted in an intensive care unit setting in Australia. This study found distracting communication in 37% of the total communication time between doctors and nurses.

    • Driven to distraction: The nature and apparent purpose of interruptions in critical care and implications for HIT

      2017, Journal of Biomedical Informatics
      Citation Excerpt :

      In this study, we empirically examined interruptions in an intensive care environment with the specific focus on their sources, including human and non-human, and their apparent purpose as inferred from field notes captured by experienced observers. Consistent with previous studies of interruptions in clinical care [1–7], our investigations found that interruptions are numerous (close to 10 interruptions per hour), affect both physicians and nurses, and happen throughout clinical shifts. Previous attempts to classify interruptions in medical care focused primarily on their sources [42,37,43] or the activities that were interrupted [6], rather than on their apparent purpose.

    • Traditions of research into interruptions in healthcare: A conceptual review

      2017, International Journal of Nursing Studies
      Citation Excerpt :

      Most of the papers explicitly or implicitly assume that interruptions are fundamentally negative events, although some mention that interruptions can be useful or are part of a clinician’s role (Weigl et al., 2012b; Alvarez and Coiera, 2005; Baethge and Rigotti, 2013; Brixey et al., 2007; Chisholm et al., 2001). A notable feature of the work by Coiera and colleagues in this cluster is the focus on communication needs being the reason for interruptions (Coiera and Tombs, 1998; Coiera et al., 2002; Alvarez and Coiera, 2005). Many of the papers are motivated by a concern that interruptions to cognitive processes will cause error (Coiera and Tombs, 1998; Coiera et al., 2002; Weigl et al., 2012b; Murji et al., 2016; Alvarez and Coiera, 2005; Potter et al., 2005; Drews, 2007).

    View all citing articles on Scopus
    View full text