Differentiating between detrimental and beneficial interruptions: a mixed-methods study
Abstract
Introduction: Efforts to understand interruptions now span much of the last decade and a half. Often thought to negatively impact patient safety, some now acknowledge that interruptions may be beneficial and actually necessary for safety and high quality care. This study seeks a framework for differentiating between interruptions that are detrimental and those that are beneficial. Methods: A mixed-methods approach at a US Level 1 trauma centre included direct observation of 13 registered nurses (RNs), survey of 47 RNs, retrospective observation of hands-free communication devices, and modelling of observed interruptions to key performance measures. Results: On average, RNs were interrupted every 11 min, with 20.3% of their workload triggered by interruptions. While 85% of RNs agreed that interruptions place their patients at risk, only 21% agreed that all should be eliminated. During one 90-min period, 18 original events spawned 68 interruptions, 50 of these repeat messages. A statistical model, with patient measures of time and comfort, revealed that alarms and call lights returning RN's attention to the patient outside the patient room are beneficial, while interruptions in the patient room are generally detrimental. Triangulating the results, we present an emerging framework for differentiating between beneficial and detrimental interruptions based on the impact of interruptions on the RN's steady treatment and attention to the patient. Conclusions: A mixed-methods approach can help distinguish between detrimental and beneficial interruptions. While interruptions breaking the delivery of steady treatment and attention to the patient are detrimental, those returning the RN's focus to the patient, as well as those supporting patient-clinician and clinician-clinician communications are beneficial. This insight may be helpful to healthcare delivery teams tasked with improving interruption-laden processes.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some kinds of interruptions, especially those providing necessary informational content for the initial task, contributed to improving nurses' cognitive processes and allowed them to achieve fast and efficient patient care.
“In a study by McCurdie et al. [5, 12], some kinds of interruptions, especially those providing necessary informational content for the initial task, contributed to improving nurses’ cognitive processes, allowing them to achieve fast and efficient patient care [4].”
From Workflow interruption and nurses’ mental workload in electronic health record tasks: An observational study (2023) · cites this paper as [4]
Some interruptions, especially those leading to nursing task switching, might be beneficial and necessary for the quality of the task.
“some interruptions, especially those leading to nursing task switching, might be beneficial and necessary for the quality of the task [4, 5].”
From Workflow interruption and nurses’ mental workload in electronic health record tasks: An observational study (2023) · cites this paper as [4]
Cites
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,174 · see citing works
Porter, M. E. (2010) · New England Journal of Medicine · doi:10.1056/nejmp1011024 · Cited by 5,084 · see citing works
Lean Thinking—Banish Waste and Create Wealth in your Corporation
Womack, J. P., & Jones, D. T. (1997) · Journal of the Operational Research Society · doi:10.1038/sj.jors.2600967 · Cited by 3,374 · see citing works
To Err Is Human : Building A Safer Health System
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000) · Cited by 2,844 · see citing works
Doyle, C., Lennox, L., & Bell, D. (2013) · BMJ Open · doi:10.1136/bmjopen-2012-001570 · Cited by 2,358 · see citing works
A User’s Manual For The IOM’s ‘Quality Chasm’ Report
Berwick, D. M. (2002) · Health Affairs · doi:10.1377/hlthaff.21.3.80 · Cited by 709 · see citing works
Through the Patientʼs Eyes: Understanding and Promoting Patient-Centered Care
Gerteis, M., Edgman‐Levitan, S., Daley, J., & Delbanco, T. L. (1997) · Journal for Healthcare Quality · doi:10.1097/01445442-199705000-00012 · Cited by 562 · see citing works
The "To Err is Human" report and the patient safety literature
Stelfox, H. T. (2006) · BMJ Quality & Safety · doi:10.1136/qshc.2006.017947 · Cited by 391 · see citing works
Operational Failures and Interruptions in Hospital Nursing
Tucker, A. L., & Spear, S. J. (2006) · Health Services Research · doi:10.1111/j.1475-6773.2006.00502.x · Cited by 382 · see citing works
Communication loads on clinical staff in the emergency department
Coiera, E. W., Jayasuriya, R., Hardy, J., Bannan, A., & Thorpe, M. E. C. (2002) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2002.tb04482.x · Cited by 379 · see citing works
The Current State of Lean Implementation in Health Care
Poksinska, B. B. (2010) · Quality Management in Health Care · doi:10.1097/qmh.0b013e3181fa07bb · Cited by 366 · see citing works
Measuring lean initiatives in health care services: issues and findings
Kollberg, B., Dahlgaard, J. J., & Brehmer, P. O. (2006) · International Journal of Productivity and Performance Management · doi:10.1108/17410400710717064 · Cited by 365 · see citing works
Interruptions and distractions in healthcare: review and reappraisal
Rivera-Rodriguez, A. J., & Karsh, B.-T. (2010) · BMJ Quality & Safety · doi:10.1136/qshc.2009.033282 · Cited by 363 · see citing works
Chisholm, C. D., Dornfeld, A. M., Nelson, D. R., & Cordell, W. H. (2001) · Annals of Emergency Medicine · doi:10.1067/mem.2001.115440 · Cited by 332 · see citing works
Interruptions in healthcare: Theoretical views
Grundgeiger, T., & Sanderson, P. M. (2008) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2008.10.001 · Cited by 264 · see citing works
Service Quality in Health Care
Kenagy, J. W. (1999) · JAMA · doi:10.1001/jama.281.7.661 · Cited by 259 · see citing works
Understanding the Cognitive Work of Nursing in the Acute Care Environment
Potter, P. A., Wolf, L., Boxerman, S. B., Grayson, D., Sledge, J., Dunagan, C., & Evanoff, B. (2005) · JONA The Journal of Nursing Administration · doi:10.1097/00005110-200507000-00004 · Cited by 241 · see citing works
Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction
Graban, M. (2008) · Cited by 202 · see citing works
Weigl, M., Müller, A., Vincent, C., Angerer, P., & Sevdalis, N. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000188 · Cited by 190 · see citing works
A Concept Analysis of the Phenomenon Interruption
Brixey, J. J., Robinson, D. J., Johnson, C. W., Johnson, T. R., Turley, J. P., & Zhang, J. (2007) · Advances in Nursing Science · doi:10.1097/00012272-200701000-00012 · Cited by 184 · see citing works
Interruptions in emergency department work: an observational and interview study
Berg, L. M., Källberg, A.-S., Göransson, K. E., Östergren, J., Florin, J., & Ehrenberg, A. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-001967 · Cited by 149 · see citing works
Interruptions in a level one trauma center: A case study
Brixey, J. J., Tang, Z., Robinson, D. J., Johnson, C. W., Johnson, T. R., Turley, J. P., Patel, V. L., & Zhang, J. (2007) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2007.04.006 · Cited by 145 · see citing works
Reducing Waste in US Health Care Systems
Bush, R. W. (2007) · JAMA · doi:10.1001/jama.297.8.871 · Cited by 133 · see citing works
Interruptions during nurses' work: A state‐of‐the‐science review
Hopkinson, S. G., & Jennings, B. M. (2012) · Research in Nursing & Health · doi:10.1002/nur.21515 · Cited by 112 · see citing works
Why Lean doesn't work for everyone
Kaplan, G. S., Patterson, S. H., Ching, J. M., & Blackmore, C. C. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003248 · Cited by 112 · see citing works
Coiera, E. W. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-000783 · Cited by 96 · see citing works
Strategies used by nurses to recover medical errors in an academic emergency department setting
Henneman, E. A., Blank, F. S. J., Gawlinski, A., & Henneman, P. L. (2006) · Applied Nursing Research · doi:10.1016/j.apnr.2005.05.006 · Cited by 81 · see citing works
Towards a hybrid method to categorize interruptions and activities in healthcare
Brixey, J. J., Robinson, D. J., Johnson, C. W., Johnson, T. R., Turley, J. P., Patel, V. L., & Zhang, J. (2006) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2006.09.018 · Cited by 69 · see citing works
Interruption and Forgetting in Knowledge‐Intensive Service Environments
Froehle, C. M., & White, D. L. (2013) · Production and Operations Management · doi:10.1111/poms.12089 · Cited by 58 · see citing works
Not All Interruptions are Created Equal: Positive Interruptions in Healthcare
Sasangohar, F., Donmez, B., Trbovich, P., & Easty, A. (2012) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/1071181312561172 · Cited by 56 · see citing works
Quality Management for Health Care Delivery
James, B. C. (1992) · Journal for Healthcare Quality · doi:10.1097/01445442-199209000-00015 · Cited by 55 · see citing works
Creating Customer-Focused Health Care Organizations
Ford, R. C., & Fottler, M. D. (2000) · Health Care Management Review · doi:10.1097/00004010-200010000-00003 · Cited by 47 · see citing works
Flow Disruptions During Trauma Care
Shouhed, D., Blocker, R. C., Gangi, A., Ley, E. J., Blaha, J., Margulies, D. R., Wiegmann, D. A., Starnes, B. W., Karl, C., Karl, R. C., et al. (2013) · World Journal of Surgery · doi:10.1007/s00268-013-2306-0 · Cited by 41 · see citing works
Queueing models for a single machine subject to multiple types of interruptions
Wu, K., McGinnis, L., & Zwart, B. (2011) · IIE Transactions · doi:10.1080/0740817x.2010.550907 · Cited by 37 · see citing works
Capturing intraoperative process deviations using a direct observational approach: the glitch method
Morgan, L. J., Robertson, E. R., Hadi, M., Catchpole, K. C., Pickering, S., New, S., Collins, P. G. S., & McCulloch, P. G. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003519 · Cited by 35 · see citing works
Evaluating a medical error taxonomy.
Brixey, J. J., Johnson, T. R., & Zhang, J. (2002) · PubMed Central · Cited by 30 · see citing works
A Theoretical Framework to Understand and Engineer Persuasive Interruptions
Walji, M. F., Brixe, J., Johnson-Throop, K. A., & Zhang, J. (2004) · eScholarship (California Digital Library) · Cited by 23 · see citing works
Uncertainties in real-world decisions on medical technologies
Lu, C. Y. (2014) · International Journal of Clinical Practice · doi:10.1111/ijcp.12434 · Cited by 9 · see citing works
Scheduling of advanced practice providers at Level 1 trauma centers
Myers, R. A., Parikh, P. J., Ekeh, A. P., Denlinger, E., & McCarthy, M. C. (2014) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000000250 · Cited by 7 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Puranik, H. G., Koopman, J., & Vough, H. C. (2019) · Journal of Management · doi:10.1177/0149206319887428 · Cited by 223 · see citing works
Shan, Y., Shang, J., Yan, Y., & Ye, X. (2023) · BMC Nursing · doi:10.1186/s12912-023-01209-9 · Cited by 79 · see citing works
“While most studies have focused on the negative aspects of interruptions, others have presented a broader view, acknowledging that some interruptions, especially those leading to nursing task switching, might be beneficial and necessary for the quality of the task [4, 5].”
BackgroundMethodInfluentialWeigl, M., Beck, J., Wehler, M., & Schneider, A. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-019074 · Cited by 76 · see citing works
“However, comfort-related interruptions that benefitted patients or their relatives were rare in comparison with interprofessional interruption contents.(14) We also observed that interruptions containing urgent alerts occurred rarely.”
InfluentialWeigl, M., Catchpole, K., Wehler, M., & Schneider, A. (2020) · Applied Ergonomics · doi:10.1016/j.apergo.2020.103155 · Cited by 56 · see citing works
Smartphone distraction during nursing care: Systematic literature review
Fiorinelli, M., Mario, S. D., Surace, A., Mattei, M., Russo, C. A., Villa, G., Dionisi, S., Simone, E. D., Giannetta, N., & Muzio, M. D. (2021) · Applied Nursing Research · doi:10.1016/j.apnr.2021.151405 · Cited by 52 · see citing works
An observational study of distractions in the operating theatre
van Harten, A., Gooszen, H. G., Koksma, J., Niessen, T., & Abma, T. (2020) · Anaesthesia · doi:10.1111/anae.15217 · Cited by 45 · see citing works
Traditions of research into interruptions in healthcare: A conceptual review
McCurdie, T., Sanderson, P., & Aitken, L. M. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2016.11.005 · Cited by 37 · see citing works
Nurses’ work with interruptions: an objective model for testing interventions
Myers, R. A., & Parikh, P. J. (2017) · Health Care Management Science · doi:10.1007/s10729-017-9417-3 · Cited by 36 · see citing works
“Those classified as beneficial include those from the patient or family, during direct care procedures, and those from other care providers while the nurse is not involved in direct care or medication activities [14].”
BackgroundInfluentialSelf-citationNursing Interruptions in a Trauma Intensive Care Unit
Starr, N. C., Myers, R. A., Eid, J. M., Parikh, P., McCarthy, M. C., Zink, K., & Parikh, P. J. (2017) · JONA The Journal of Nursing Administration · doi:10.1097/nna.0000000000000466 · Cited by 22 · see citing works
Self-citationSchneider, A., Wehler, M., & Weigl, M. (2018) · BMJ Quality & Safety · doi:10.1136/bmjqs-2018-007811 · Cited by 19 · see citing works
Teigné, D., Cazet, L., Birgand, G., Moret, L., Maupetit, J.-C., Mabileau, G., & Terrien, N. (2023) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzad069 · Cited by 19 · see citing works
“However, interruptions can be beneficial [29].”
BackgroundMamykina, L., Carter, E. J., Sheehan, B., Hum, R. S., Twohig, B., & Kaufman, D. R. (2017) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2017.01.015 · Cited by 16 · see citing works
“For example, disambiguating between beneficial and detrimental interruptions remains nontrivial and requires a deeper understanding of why interruptions occur, and, often, adopting a particular perspective: interruptions deemed detrimental by patients may be viewed as necessary and beneficial by clinicians (18).”
BackgroundBarbieri, B., Mondo, M., Simone, S. D., Pinna, R., Galletta, M., Pileri, J., & Bellini, D. (2024) · Societies · doi:10.3390/soc14040050 · Cited by 16 · see citing works
Interruptions During Senior Nurse Handover in the Intensive Care Unit
Spooner, A. J., Chaboyer, W. P., & Aitken, L. M. (2018) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000345 · Cited by 12 · see citing works
“These include using a written or printed document or portable device containing structured handover information to accompany handover so that clinicians can revisit their notes if they are distracted, minimizing memory loss and omission of critical information due to the interruption.(18,21,25) McCurdie et al(11) reco…”
BackgroundMethodInfluentialHope, J., Dall’Ora, C., Redfern, O., Darbyshire, J. L., & Griffiths, P. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105018 · Cited by 9 · see citing works
“This challenges existing conceptualisations of interruptions that attempt to differentiate between beneficial (or necessary) and detrimental interruptions (Myers et al., 2016).”
InfluentialDesigning Guidelines for Mobile Health Technology
Srinivas, P., Faiola, A. J., & Mark, G. J. (2016) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/2858036.2858553 · Cited by 9 · see citing works
Thibault, M., Porteils, C., Goulois, S., Levy, A. R., Lebel, D., & Bussières, J. (2018) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000350 · Cited by 7 · see citing works
Improving efficiency within a trauma nurse practitioner team
Atkinson, S., Crutcher, T. D., & King, J. E. (2020) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000425 · Cited by 5 · see citing works
“Several studies found that the interruptions negatively affect the quality and safety of patient care (Allard et al., 2011; Myers et al., 2016; Ratwani et al., 2017; Weigel et al., 2014; Westbrook et al., 2018; Westbrook et al., 2010).”
BackgroundSurgical counting interruptions in operating rooms
Zhi, L.-J., Gao, Y., & Wei, W. (2024) · BMC Nursing · doi:10.1186/s12912-024-01912-1 · Cited by 4 · see citing works
“Meanwhile, targeted strategies, such as training nurses to distinguish between detrimental and beneficial interruptions as well as perfecting their ability to respond to interruptions, may be effective [23, 24].”
BackgroundThe Research Review and Hot Topics Analysis of Work Disruption from an Organizational Perspective
Zou, L., & Ren, W. (2022) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/assehr.k.220504.513 · Cited by 1 · see citing works
Ghani, T., Abbas, J., & Sarwat, N. (2025) · Canadian Journal of Administrative Sciences-revue Canadienne Des Sciences De L Administration · doi:10.1002/cjas.70013 · Cited by 1 · see citing works
Interrupções no trabalho do enfermeiro e na segurança do paciente
Paiva, A. C. D. O., Oliveira, D. S. D., Silva, M. A. C., Maia, M. A., & Alves, M. (2019) · Revista de Enfermagem UFPE on line · doi:10.5205/1981-8963.2019.240082 · Cited by 1 · see citing works
“10; 13-7; 19 Sabe-se que a troca de informações entre os profissionais, além de otimizar a assistência ao paciente, permite o gerenciamento dos cuidados de Enfermagem.(3,10,24) Acrescenta-se que a interrupção pode favorecer a troca de experiências entre os profissionais, o que facilita a tomada de decisão do enfermeir…”
BackgroundInfluentialSpooner, A. J. (2018) · Griffith Research Online · doi:10.25904/1912/3732
Sfez, M., & Mounier, G. (2025) · Risques & qualité en milieu de soins · doi:10.3917/rqms.402.0122
An Integrative Review of Work Interruptions and Future Research Directions
高, 世. (2025) · Advances in Psychology · doi:10.12677/ap.2025.1510563
Shan, Y., Shang, J., Yan, Y., & Ye, X. (2023) · Figshare · doi:10.6084/m9.figshare.22617770
Additional file 1 of Surgical counting interruptions in operating rooms
Zhi, L.-J., Yuan, G., & Wei, W. (2024) · Figshare · doi:10.6084/m9.figshare.25583956
Shan, Y., Shang, J., Yan, Y., & Ye, X. (2023) · Figshare · doi:10.6084/m9.figshare.22617767
Multitasking and interruptions in control rooms: occurrences, reasons and coping strategies
Tang, H., Gao, Q., Li, X., & Kang, Y. (2026) · Ergonomics · doi:10.1080/00140139.2026.2639016
abbaszadeh, S. M., Poursaadat, N., Karimi, N., Zarei, R., & Nayeri, N. D. (2026) · Research Square · doi:10.21203/rs.3.rs-10305529/v1
- Authors
- Myers, R. A., McCarthy, M. C., Whitlatch, A., & Parikh, P. J.
- Affiliations
- Wright State University (US)
- Miami Valley Hospital (US)
- Corresponding author
- Parikh, Pratik J
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2015-11-16
- Volume
- 25
- Issue
- 11
- Pages
- 881-888
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- OpenAlex
- W2236370404
- Cited by
- 30
- References
- 39
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 2
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Social Sciences › Decision Sciences › Information Systems and Management › Personal Information Management and User Behavior
- Keywords
- patient safety, registered nurses, nursing workload, patient comfort, patient-clinician communication, trauma care
- MeSH terms
- Patient Comfort, Humans, Nursing Staff, Hospital, Retrospective Studies, Task Performance and Analysis, Time Factors, Trauma Centers, Models, Statistical, Workload, Process Assessment, Health Care, Workflow, Patient Safety
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
