Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study

Nina M. Dadlez, Gabriella Azzarone, Mark J. Sinnett, Micah Resnick, H. Michael Ushay, Jason S. Adelman, Molly Broder, Carol Duh-Leong, Joyce Huang, Victoria Kiely, Ariella Nadler, Vayola Nelson, Jared Simcik, Michael L. Rinke

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: By self-report, interruptions may contribute to up to 80% of ordering errors. A greater understanding of the frequency and context of interruptions during ordering is needed to identify targets for intervention. We sought to characterize the epidemiology of interruptions during order placement in the pediatric inpatient setting.

METHODS: This prospective observational study conducted 1-hour-long structured observations on morning rounds and afternoons and evenings in the resident workroom. The primary outcome was the number of interruptions per 100 orders placed by residents and physician assistants. We assessed the role of ordering provider, number, type and urgency of interruptions and person initiating interruption. Descriptive statistics, χ2, and run charts were used.

RESULTS: Sixty-nine structured observations were conducted with a total of 414 orders included. The interruption rate was 65 interruptions per 100 orders during rounds, 55 per 100 orders in the afternoons and 56 per 100 orders in the evenings. The majority of interruptions were in-person (n = 144, 61%). Interruptions from overhead announcements occurred most often in the mornings, and phone interruptions occurred most often in the evenings (P = .002). Nurses initiated interruptions most frequently. Attending physicians and fellows were more likely to interrupt during rounds, and coresidents were more likely to interrupt in the evenings (P = .002).

CONCLUSIONS: Residents and physician assistants are interrupted at a rate of 57 interruptions per 100 orders placed. This may contribute to ordering errors and worsen patient safety. Efforts should be made to decrease interruptions during the ordering process and track their effects on medication errors.

Original languageEnglish (US)
Pages (from-to)134-139
Number of pages6
JournalHospital pediatrics
Volume7
Issue number3
DOIs
StatePublished - Mar 1 2017

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Physician Assistants
Tertiary Care Centers
Observational Studies
Prospective Studies
Teaching Rounds
Medication Errors
Patient Safety
Self Report
Inpatients
Epidemiology
Nurses
Pediatrics
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Dadlez, N. M., Azzarone, G., Sinnett, M. J., Resnick, M., Ushay, H. M., Adelman, J. S., ... Rinke, M. L. (2017). Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study. Hospital pediatrics, 7(3), 134-139. https://doi.org/10.1542/hpeds.2016-0127

Ordering Interruptions in a Tertiary Care Center : A Prospective Observational Study. / Dadlez, Nina M.; Azzarone, Gabriella; Sinnett, Mark J.; Resnick, Micah; Ushay, H. Michael; Adelman, Jason S.; Broder, Molly; Duh-Leong, Carol; Huang, Joyce; Kiely, Victoria; Nadler, Ariella; Nelson, Vayola; Simcik, Jared; Rinke, Michael L.

In: Hospital pediatrics, Vol. 7, No. 3, 01.03.2017, p. 134-139.

Research output: Contribution to journalArticle

Dadlez, NM, Azzarone, G, Sinnett, MJ, Resnick, M, Ushay, HM, Adelman, JS, Broder, M, Duh-Leong, C, Huang, J, Kiely, V, Nadler, A, Nelson, V, Simcik, J & Rinke, ML 2017, 'Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study', Hospital pediatrics, vol. 7, no. 3, pp. 134-139. https://doi.org/10.1542/hpeds.2016-0127
Dadlez NM, Azzarone G, Sinnett MJ, Resnick M, Ushay HM, Adelman JS et al. Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study. Hospital pediatrics. 2017 Mar 1;7(3):134-139. https://doi.org/10.1542/hpeds.2016-0127
Dadlez, Nina M. ; Azzarone, Gabriella ; Sinnett, Mark J. ; Resnick, Micah ; Ushay, H. Michael ; Adelman, Jason S. ; Broder, Molly ; Duh-Leong, Carol ; Huang, Joyce ; Kiely, Victoria ; Nadler, Ariella ; Nelson, Vayola ; Simcik, Jared ; Rinke, Michael L. / Ordering Interruptions in a Tertiary Care Center : A Prospective Observational Study. In: Hospital pediatrics. 2017 ; Vol. 7, No. 3. pp. 134-139.
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AU - Resnick, Micah

AU - Ushay, H. Michael

AU - Adelman, Jason S.

AU - Broder, Molly

AU - Duh-Leong, Carol

AU - Huang, Joyce

AU - Kiely, Victoria

AU - Nadler, Ariella

AU - Nelson, Vayola

AU - Simcik, Jared

AU - Rinke, Michael L.

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N2 - OBJECTIVES: By self-report, interruptions may contribute to up to 80% of ordering errors. A greater understanding of the frequency and context of interruptions during ordering is needed to identify targets for intervention. We sought to characterize the epidemiology of interruptions during order placement in the pediatric inpatient setting.METHODS: This prospective observational study conducted 1-hour-long structured observations on morning rounds and afternoons and evenings in the resident workroom. The primary outcome was the number of interruptions per 100 orders placed by residents and physician assistants. We assessed the role of ordering provider, number, type and urgency of interruptions and person initiating interruption. Descriptive statistics, χ2, and run charts were used.RESULTS: Sixty-nine structured observations were conducted with a total of 414 orders included. The interruption rate was 65 interruptions per 100 orders during rounds, 55 per 100 orders in the afternoons and 56 per 100 orders in the evenings. The majority of interruptions were in-person (n = 144, 61%). Interruptions from overhead announcements occurred most often in the mornings, and phone interruptions occurred most often in the evenings (P = .002). Nurses initiated interruptions most frequently. Attending physicians and fellows were more likely to interrupt during rounds, and coresidents were more likely to interrupt in the evenings (P = .002).CONCLUSIONS: Residents and physician assistants are interrupted at a rate of 57 interruptions per 100 orders placed. This may contribute to ordering errors and worsen patient safety. Efforts should be made to decrease interruptions during the ordering process and track their effects on medication errors.

AB - OBJECTIVES: By self-report, interruptions may contribute to up to 80% of ordering errors. A greater understanding of the frequency and context of interruptions during ordering is needed to identify targets for intervention. We sought to characterize the epidemiology of interruptions during order placement in the pediatric inpatient setting.METHODS: This prospective observational study conducted 1-hour-long structured observations on morning rounds and afternoons and evenings in the resident workroom. The primary outcome was the number of interruptions per 100 orders placed by residents and physician assistants. We assessed the role of ordering provider, number, type and urgency of interruptions and person initiating interruption. Descriptive statistics, χ2, and run charts were used.RESULTS: Sixty-nine structured observations were conducted with a total of 414 orders included. The interruption rate was 65 interruptions per 100 orders during rounds, 55 per 100 orders in the afternoons and 56 per 100 orders in the evenings. The majority of interruptions were in-person (n = 144, 61%). Interruptions from overhead announcements occurred most often in the mornings, and phone interruptions occurred most often in the evenings (P = .002). Nurses initiated interruptions most frequently. Attending physicians and fellows were more likely to interrupt during rounds, and coresidents were more likely to interrupt in the evenings (P = .002).CONCLUSIONS: Residents and physician assistants are interrupted at a rate of 57 interruptions per 100 orders placed. This may contribute to ordering errors and worsen patient safety. Efforts should be made to decrease interruptions during the ordering process and track their effects on medication errors.

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