The University of Utah, Salt Lake City, USA.
Hum Factors. 2019 Jun;61(4):564-576. doi: 10.1177/0018720819838090. Epub 2019 Apr 4.
This study samples interruption frequency in intensive care unit (ICU) settings to assess the relationship between interruptions and common patient hazards.
Task interruptions are accident contributors in numerous industries. Recently, studies on health care interruptions and their impact on patient hazards have received attention.
Seven ICUs in four hospitals participated in a 24-month study. Experienced ICU nurses directly observed nursing tasks, interruptions, and patient hazards (delays in care, breaks in device task protocols, and patient safety hazards).
During 1,148 hours of observation, 175 nurses performed 74,733 nursing tasks. Interruptions occurred at a rate of 4.95 per hour, and 8.4% of tasks were interrupted. Interruptions originated mostly from humans (65.9%), alarms (24.1%), and others (10%). A total of 774 patient hazards were observed, with a hazard occurring on average every 89 minutes. Relative to noninterrupted tasks, device alarm interrupted nonstructured tasks were associated with increased rates of delays in care and safety hazards (rate ratio [RR] = 3.19). In contrast, rate of delays in care and safety hazards did not increase during human interrupted tasks (RR = 1.13). Rates of protocol nonadherence varied by device type and were highest during artificial airway, medication administration, chest tube, and supplemental oxygen management.
Interruptions in the ICU are frequent and contribute to patient hazards, especially when caused by device alarms during nonstructured tasks. Nonadherence to protocols is common and contributed to patient hazards.
The findings suggest a need for improvement in task and device design to reduce patient hazards.
本研究以重症监护病房（ICU）中的中断频率为样本，评估中断与常见患者危险之间的关系。
任务中断是许多行业事故的诱因。最近，对医疗保健中断及其对患者危害的影响的研究引起了关注。
四家医院的七个 ICU 参与了一项为期 24 个月的研究。经验丰富的 ICU 护士直接观察护理任务、中断和患者危险（护理延迟、设备任务协议中断和患者安全危险）。
在 1148 小时的观察中，175 名护士完成了 74733 项护理任务。中断率为每小时 4.95 次，8.4%的任务被中断。中断主要来自于人为因素（65.9%）、警报（24.1%）和其他因素（10%）。共观察到 774 例患者危险，平均每 89 分钟发生一次危险。与非中断任务相比，设备报警中断非结构化任务与护理延迟和安全危险的发生率增加有关（比率比[RR] = 3.19）。相比之下，在人为中断任务中，护理延迟和安全危险的发生率没有增加（RR = 1.13）。协议不遵守的发生率因设备类型而异，在人工气道、药物管理、胸腔引流管和补充氧气管理中最高。
ICU 中的中断很频繁，会导致患者危险，尤其是在非结构化任务中由设备警报引起的中断。不遵守协议很常见，会导致患者危险。
研究结果表明，需要改进任务和设备设计，以减少患者危险。
