An Experimental Study on the Impact of Clinical Interruptions on Simulated Trainee Performances of Central Venous Catheterization

Overview

Journal Adv Simul (Lond)

Publisher Biomed Central

Date 2018 Feb 17

PMID 29450006

Citations 4

Authors

Jessica Jones

Matthew Wilkins

Jeff Caird

Alyshah Kaba

Adam Cheng

Irene W Y Ma

Affiliations

Soon will be listed here.

Abstract

Background: Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task.

Methods: Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, = 15) or (2) minimally complex: skin cleansing (control group, = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access.

Results: Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: (2, 44) = 4.28, = 0.02, and partial eta = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1-7 vs. 1, IQR 1-2; = 0.03).

Conclusions: Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.

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References

Raad I . Intravascular-catheter-related infections. Lancet. 1998; 351(9106):893-8. DOI: 10.1016/S0140-6736(97)10006-X. View

Ma I, Sharma N, Brindle M, Caird J, McLaughlin K . Measuring competence in central venous catheterization: a systematic-review. Springerplus. 2014; 3:33. PMC: 3909608. DOI: 10.1186/2193-1801-3-33. View

Goodell K, Cao C, Schwaitzberg S . Effects of cognitive distraction on performance of laparoscopic surgical tasks. J Laparoendosc Adv Surg Tech A. 2006; 16(2):94-8. DOI: 10.1089/lap.2006.16.94. View

Pape T, Guerra D, Muzquiz M, Bryant J, Ingram M, Schranner B . Innovative approaches to reducing nurses' distractions during medication administration. J Contin Educ Nurs. 2005; 36(3):108-16. DOI: 10.3928/0022-0124-20050501-08. View

Walzak A, Bacchus M, Schaefer J, Zarnke K, Glow J, Brass C . Diagnosing technical competence in six bedside procedures: comparing checklists and a global rating scale in the assessment of resident performance. Acad Med. 2015; 90(8):1100-8. DOI: 10.1097/ACM.0000000000000704. View

Parenti C, Lurie N . Are things different in the light of day? A time study of internal medicine house staff days. Am J Med. 1993; 94(6):654-8. DOI: 10.1016/0002-9343(93)90220-j. View

Ma I, Pugh D, Mema B, Brindle M, Cooke L, Stromer J . Use of an error-focused checklist to identify incompetence in lumbar puncture performances. Med Educ. 2015; 49(10):1004-15. PMC: 4584502. DOI: 10.1111/medu.12809. View

McGee D, Gould M . Preventing complications of central venous catheterization. N Engl J Med. 2003; 348(12):1123-33. DOI: 10.1056/NEJMra011883. View

Hsu K, Man F, Gizicki R, Feldman L, Fried G . Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc. 2007; 22(1):196-201. DOI: 10.1007/s00464-007-9452-0. View

10.

Ly T, Korb-Wells C, Sumpton D, Russo R, Barnsley L . Nature and impact of interruptions on clinical workflow of medical residents in the inpatient setting. J Grad Med Educ. 2014; 5(2):232-7. PMC: 3693686. DOI: 10.4300/JGME-D-12-00040.1. View

11.

Coiera E . The science of interruption. BMJ Qual Saf. 2012; 21(5):357-60. DOI: 10.1136/bmjqs-2012-000783. View

12.

Monteiro S, Sherbino J, Ilgen J, Dore K, Wood T, Young M . Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians?. Acad Med. 2015; 90(4):511-7. DOI: 10.1097/ACM.0000000000000614. View

13.

Ma I, Zalunardo N, Pachev G, Beran T, Brown M, Hatala R . Comparing the use of global rating scale with checklists for the assessment of central venous catheterization skills using simulation. Adv Health Sci Educ Theory Pract. 2011; 17(4):457-70. DOI: 10.1007/s10459-011-9322-3. View

14.

Miller G . The magical number seven plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1956; 63(2):81-97. View

15.

Feller-Kopman D . Ultrasound-guided central venous catheter placement: the new standard of care?. Crit Care Med. 2005; 33(8):1875-7. DOI: 10.1097/01.ccm.0000174483.90346.60. View

16.

Alvarez G, Coiera E . Interruptive communication patterns in the intensive care unit ward round. Int J Med Inform. 2005; 74(10):791-6. DOI: 10.1016/j.ijmedinf.2005.03.017. View

17.

Wiegmann D, ElBardissi A, Dearani J, Daly R, Sundt 3rd T . Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery. 2007; 142(5):658-65. DOI: 10.1016/j.surg.2007.07.034. View

18.

Healey A, Sevdalis N, Vincent C . Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics. 2006; 49(5-6):589-604. DOI: 10.1080/00140130600568899. View

19.

Ortega R, Song M, Hansen C, Barash P . Videos in clinical medicine. Ultrasound-guided internal jugular vein cannulation. N Engl J Med. 2010; 362(16):e57. DOI: 10.1056/NEJMvcm0810156. View

20.

Brixey J, Tang Z, Robinson D, Johnson C, Johnson T, Turley J . Interruptions in a level one trauma center: a case study. Int J Med Inform. 2007; 77(4):235-41. PMC: 2670398. DOI: 10.1016/j.ijmedinf.2007.04.006. View