Presentation
HE18 - Scoping Review on Studies That Evaluate Effect of Built Environmental Features on interruptions during clinical procedures
SessionPoster Session 1
DescriptionIntroduction. Studies have shown that interruptions are a significant cause of errors, which are a primary contributor to adverse events that can result in severe injury or even death. These interruptions play a pivotal role in causing medication errors. Built environmental factors frequently lead to numerous interruptions during the medication administration process. Despite this, there is a scarcity of comprehensive studies reviewing how these environmental variables influence the frequency of interruptions. In healthcare settings where interdisciplinary teams operate dynamically and information fluctuates rapidly, even small interruptions can have a significant impact on patient care. These interruptions can lead to the loss of critical knowledge, memory lapses, and eventually, medical errors. Therefore, it is essential to consider how the physical environment exacerbates or alleviates disruptions to enhance patient safety.
Study Purpose and Research Questions. This study evaluates articles that analyze the influence of built environmental factors on the occurrence of interruptions during clinical procedures. The primary goal is to assess how physical environmental features contribute to interruptions and how extensively this relationship has been examined in literature. Our evaluation was guided by three key questions: What data collection methods are used? What is the level of evidence? What are the key findings?
Methodology. A scoping review was conducted on empirical studies that evaluated the effect of built environmental factors on interruptions. Data was extracted from the articles using a standard set of elements, including author affiliation, setting (country, hospital, unit), publication year, study design, purpose, data collection methods, study participants or sample, clinical procedures, and key interruption findings. The measured variables included independent variables related to both physical and non-physical environmental factors, as well as outcome variables.
Findings. The review synthesized findings from 34 empirical studies. This study showed that interruption, distraction, and disruption terminologies were defined differently across studies, affecting research design and interpretation. Of the reviewed studies, 13 used "interruption," five used "disruption," and five used both "distraction" and "interruption." The studies were conducted in various clinical settings, including medical and surgical units, operating rooms, emergency departments, ICUs, and more specialized units such as pediatric post-anesthesia care units (PACUs). Study participants included nurses, physicians, pharmacists, patients, and various support staff.
Studies were categorized into two main types: observational and experimental. Observational studies (n=10) examined the natural occurrence of interruptions without any intervention. These studies aimed to understand the frequency, characteristics, and contributing factors of interruptions, both environmental and non-environmental. By observing interruptions in their natural setting, these studies provided valuable insights into the underlying causes and patterns of interruption behavior. Experimental studies (n=16), which included interventional and quasi-experimental designs, focused on evaluating the effectiveness of various interventions in reducing interruptions. These studies manipulated one or more variables (the intervention or factor) and measured the outcome (interruptions). The goal was to identify the most effective approaches for minimizing interruptions and to understand how different interventions influenced interruption frequency. The primary data collection methods used were observation, interviews, and surveys. Some studies also relied on self-reported interruptions and distractions. These methods varied according to the study designs and the objectives of the research. Video recordings and focus groups were occasionally used to supplement the data collected through direct observation.
The study variables were categorized into three groups: environmental, non-environmental, and outcome variables. Environmental features were studied to assess their impact on reducing interruptions. The concept of no-interruption zones (NIZ) was examined extensively where specific areas were designated to be interruption-free through signage and physical barriers or even the red taped on the floor, and their impact on reducing interruptions was investigated. Other variables related to the physical environment include signage, quiet zones, medication room type (joined or separated/ dedicated) operating rooms (OR) wall barriers (visual and physical separation), layout of workstations (open vs. enclosed), traffic-related factors, and ward environment characteristics like noise. Non-environmental Variables include factors that are not related to the physical environment but rather to the processes, protocols, and human factors involved in healthcare delivery. They include standard protocols, educational interventions, red tabard vests, staff training, checklists, frequently used drug handbooks, communication strategies, and staff positioning during handoffs. The outcome variables measured the effectiveness of the interventions in reducing interruptions and distractions. These metrics included the number of distractions, flow disruptions, interruption duration, percentage of interruptions, interruption-free preparation time, frequency of interruptions, and the reasons for interruptions.
Conclusion. This scoping review highlights the critical role of built environmental features in influencing the frequency of interruptions during the medication process, which can significantly contribute to medical errors and adverse events. The findings emphasize that while some environmental interventions, such as the establishment of no-interruption zones (NIZ), quiet zones, and dedicated medication rooms, have been extensively studied, there remains a substantial gap in understanding the broader range of design features and their impact on interruptions. This gap is particularly pronounced in areas such as the layout of clinical areas and traffic-related factors which can play a pivotal role in either mitigating or exacerbating interruptions. The research also reveals inconsistencies in how interruptions, distractions, and disruptions are defined and measured, which hinders the comparability of results across studies and suggests the need for standardized definitions and methodologies.
Ultimately, this study underscores the need for more empirical research that systematically examines the influence of various built environment features on interruptions across different healthcare settings. By addressing these gaps, healthcare facilities can enhance patient safety, improve workflow efficiency, and reduce the occurrence of errors. Future research should focus on integrating design solutions with operational protocols to create safer and more efficient clinical environments.
Study Purpose and Research Questions. This study evaluates articles that analyze the influence of built environmental factors on the occurrence of interruptions during clinical procedures. The primary goal is to assess how physical environmental features contribute to interruptions and how extensively this relationship has been examined in literature. Our evaluation was guided by three key questions: What data collection methods are used? What is the level of evidence? What are the key findings?
Methodology. A scoping review was conducted on empirical studies that evaluated the effect of built environmental factors on interruptions. Data was extracted from the articles using a standard set of elements, including author affiliation, setting (country, hospital, unit), publication year, study design, purpose, data collection methods, study participants or sample, clinical procedures, and key interruption findings. The measured variables included independent variables related to both physical and non-physical environmental factors, as well as outcome variables.
Findings. The review synthesized findings from 34 empirical studies. This study showed that interruption, distraction, and disruption terminologies were defined differently across studies, affecting research design and interpretation. Of the reviewed studies, 13 used "interruption," five used "disruption," and five used both "distraction" and "interruption." The studies were conducted in various clinical settings, including medical and surgical units, operating rooms, emergency departments, ICUs, and more specialized units such as pediatric post-anesthesia care units (PACUs). Study participants included nurses, physicians, pharmacists, patients, and various support staff.
Studies were categorized into two main types: observational and experimental. Observational studies (n=10) examined the natural occurrence of interruptions without any intervention. These studies aimed to understand the frequency, characteristics, and contributing factors of interruptions, both environmental and non-environmental. By observing interruptions in their natural setting, these studies provided valuable insights into the underlying causes and patterns of interruption behavior. Experimental studies (n=16), which included interventional and quasi-experimental designs, focused on evaluating the effectiveness of various interventions in reducing interruptions. These studies manipulated one or more variables (the intervention or factor) and measured the outcome (interruptions). The goal was to identify the most effective approaches for minimizing interruptions and to understand how different interventions influenced interruption frequency. The primary data collection methods used were observation, interviews, and surveys. Some studies also relied on self-reported interruptions and distractions. These methods varied according to the study designs and the objectives of the research. Video recordings and focus groups were occasionally used to supplement the data collected through direct observation.
The study variables were categorized into three groups: environmental, non-environmental, and outcome variables. Environmental features were studied to assess their impact on reducing interruptions. The concept of no-interruption zones (NIZ) was examined extensively where specific areas were designated to be interruption-free through signage and physical barriers or even the red taped on the floor, and their impact on reducing interruptions was investigated. Other variables related to the physical environment include signage, quiet zones, medication room type (joined or separated/ dedicated) operating rooms (OR) wall barriers (visual and physical separation), layout of workstations (open vs. enclosed), traffic-related factors, and ward environment characteristics like noise. Non-environmental Variables include factors that are not related to the physical environment but rather to the processes, protocols, and human factors involved in healthcare delivery. They include standard protocols, educational interventions, red tabard vests, staff training, checklists, frequently used drug handbooks, communication strategies, and staff positioning during handoffs. The outcome variables measured the effectiveness of the interventions in reducing interruptions and distractions. These metrics included the number of distractions, flow disruptions, interruption duration, percentage of interruptions, interruption-free preparation time, frequency of interruptions, and the reasons for interruptions.
Conclusion. This scoping review highlights the critical role of built environmental features in influencing the frequency of interruptions during the medication process, which can significantly contribute to medical errors and adverse events. The findings emphasize that while some environmental interventions, such as the establishment of no-interruption zones (NIZ), quiet zones, and dedicated medication rooms, have been extensively studied, there remains a substantial gap in understanding the broader range of design features and their impact on interruptions. This gap is particularly pronounced in areas such as the layout of clinical areas and traffic-related factors which can play a pivotal role in either mitigating or exacerbating interruptions. The research also reveals inconsistencies in how interruptions, distractions, and disruptions are defined and measured, which hinders the comparability of results across studies and suggests the need for standardized definitions and methodologies.
Ultimately, this study underscores the need for more empirical research that systematically examines the influence of various built environment features on interruptions across different healthcare settings. By addressing these gaps, healthcare facilities can enhance patient safety, improve workflow efficiency, and reduce the occurrence of errors. Future research should focus on integrating design solutions with operational protocols to create safer and more efficient clinical environments.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)