Grundgeiger Tobias, Sanderson Penelope
School of Psychology, The University of Queensland, Australia.
Int J Med Inform. 2009 May;78(5):293-307. doi: 10.1016/j.ijmedinf.2008.10.001. Epub 2008 Dec 9.
Researchers in healthcare have begun to investigate interruptions extensively, given evidence for the adverse effects of work interruptions in other domains and given the highly interruptive hospital environment. In this paper, we reviewed literature on interruptions in critical care and medication dispensing settings in search of evidence for a relationship between interruptions and adverse events.
The literature search included the databases MEDLINE, CINAHL+Pre CINHAL, Health Sources: Nursing Academic Edition, EMBASE, PsycINFO, ISI Web of Science and Ergonomics Abstracts. The paper titles and abstracts were subsequently reviewed. After the initial search, we reviewed paper titles and abstracts to define the subset for review.
We currently lack evidence in healthcare of the extent to which interruptions lead to adverse effects. The lack of evidence may be due to the descriptive rather than causal nature of most studies, the lack of theory motivating investigations of the relationship, the fact that healthcare is a complex and varied domain, and inadequate conceptualizations of accident aetiology. We identify two recent accident theories in which the relationship between activity and medical errors is complex, indicating that even when it is sought, causal evidence is hard to find.
Future research on interruptions in healthcare settings should focus on the following. First, prospective memory research and distributed cognition can provide a theoretical background for understanding the impact of interruptions and so could provide guidance for future empirical research on interruptions and the planning of actions in healthcare. Second, studying how interruptions are successfully rather than unsuccessfully overcome may better help us understand their effects. Third, because interruptions almost always have positive and adverse effects, more appropriate dependent variables could be chosen.
鉴于工作中断在其他领域的不利影响的证据以及医院环境高度易被打断的情况，医疗保健领域的研究人员已开始广泛调查工作中断问题。在本文中，我们回顾了关于重症监护和药物调配环境中工作中断的文献，以寻找工作中断与不良事件之间关系的证据。
文献检索包括MEDLINE、CINAHL + Pre CINHAL、Health Sources: Nursing Academic Edition、EMBASE、PsycINFO、ISI Web of Science和Ergonomics Abstracts等数据库。随后对论文标题和摘要进行了审查。在初步检索之后，我们审查了论文标题和摘要以确定用于审查的子集。
我们目前在医疗保健领域缺乏关于工作中断导致不利影响程度的证据。缺乏证据可能是由于大多数研究的描述性而非因果性本质、缺乏推动对这种关系进行调查的理论、医疗保健是一个复杂且多样的领域这一事实以及对事故病因的概念化不足。我们确定了两种近期的事故理论，其中活动与医疗错误之间的关系很复杂，这表明即使去寻找，因果证据也很难找到。
未来关于医疗保健环境中工作中断的研究应关注以下方面。首先，前瞻性记忆研究和分布式认知可以为理解工作中断的影响提供理论背景，从而可以为未来关于工作中断的实证研究以及医疗保健中的行动规划提供指导。其次，研究如何成功而非不成功地克服工作中断可能会更好地帮助我们理解其影响。第三，由于工作中断几乎总是有积极和消极影响，可以选择更合适的因变量。
