How Interruptions in the ER Affect Nurses’ Work Flow


A new study investigates the impact of interruptions in the emergency room. Here are the disturbing results



Interruptions in the emergency room can impact work flow and those interruptions are most likely to occur during two key events-EHR documentation and direct patient care, according to a new study.

The study published online March 9, 2018, in the International Journal of Computer-Human Interaction, provided the detailed quantitative analysis of how small interruptions, such as phone calls, colleagues, residents, doctors, or patients’ family members, influence ER nurses’ mental workload, as they are expected to  take blood, start IVs, administer medications, and assess patients, among other things.




Jung Hyup Kim is an assistant professor in the Department of Industrial and Manufacturing Systems Engineering at the University of Missouri, and colleagues conducted a time study to collect ER nurses’ behaviors related to clinical activities at the Mayo Clinic in Minnesota.

“After a time study in the ER at the Mayo Clinic and a hierarchical task analysis were conducted, the models for both non-interruption and interruption case were developed,” says Kim.

The result showed that the nurses’ mental workload was 2.04 times higher during patient care activities and 4.72 times higher during EHR charting in the interruption scenario, the authors wrote.

In this study, Kim and his colleagues offered three tips to help nurses better cope with interruptions:

  • Educate ER staff. “The nurses need to be aware of how the small interruptions can significantly influence their mental workload and productivity during patient care and [EHR] documenting activities,” says Kim. “They should be trained to respond these small interruptions when they are not doing patient care and [EHR] activities.”
  • Bookmark important EHR pages. “We recommended to provide visual retrieval cues in [EHR] systems (e.g., small thumbnail images of prior suspended activity) that could positively influence the nurses to reconstruct the mental context of what they did in the past,” Kim says.
  • Control ER work flow. Currently, the nurse’s work flow in the ER is not designed to prevent nested interruption, according to Kim. “By controlling ED work flow, such as providing sensor-driven interruption awareness display, delaying self-initiated disruptions, or preventing multitasking, the occurrence of the nested interruptions would be minimized,” he says.

The findings of this study will contribute to developing a new way to measure nursing mental workload caused by the interruptions, according to the researchers.

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