RESEARCH
INTERRUPTIONS EXPERIENCED BY EMERGENCY
NURSES: IMPLICATIONS FOR SUBJECTIVE AND
OBJECTIVE MEASURES OF WORKLOAD
Authors: Katherine L. Forsyth, PhD, Hunter J. Hawthorne, BS, Nibras El-Sherif, MBBS, Rachelen S. Varghese, MHA,
Vickie K. Ernste, DNP, RN, Jordyn Koenig, and Renaldo C. Blocker, PhD, Rochester, MN, Flint, MI, and Ames, IA
Contribution to Emergency Nursing Practice
• Emergency nurses perceived their own workload accurately.
• Interruptions occur every 6 to 7 minutes for emergency nurses.
• Frequency of interruptions increased the nursing staff
workload overall.
Abstract
Introduction: This study aimed to describe interruptions
experienced by emergency nurses and establish convergence
validity of 1 objective workload measure by linking interruption
characteristics to objective and subjective measures of workload.
Methods: Interruptions were captured in real time across 8- or
12-hour shifts using a previously validated Workflow Interrup-
tions Tool (WIT). Data collected on each interruption included
type, priority, and location where the interruption occurred. At
mid- and end-shift, the Surgery Task Load Index (SURG-TLX) and
the Rapid Cognitive Assessment Tool (RCAT) were administered
Katherine L. Forsyth is Assistant Professor of Health Systems Engineering at Robert
D. and Patricia E. Kern Center for the Science of Health Care Delivery and
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Hunter J. Hawthorne is at Associate Health Systems Analyst Robert D. and
Patricia E. Kern Center for the Science of Health Care Delivery and
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Nibras El-Sherif is at Hurley Medical Center, Department of Pediatrics, Flint, MI.
Rachelen S. Varghese is Pediatric Resident at the Mayo Clinic Department of
Emergency Medicine, Mayo Clinic, Rochester, MN.
Vickie K. Ernste is Manager at Department of Emergency Medicine and is
Instructor of Nursing at College of Medicine, Mayo Clinic, Rochester, MN.
Jordyn Koenig is at Undergraduate Student Department of Industrial Engineering, Iowa
State University, Ames, IA.
Renaldo C. Blocker is Associate Consultant and Assistant Professor of Health Systems
Engineering at Robert D. and Patricia E. Kern Center for the Science of Health Care
Delivery and Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
For correspondence, write: Renaldo C. Blocker, PhD, Department of Health
Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905;
E-mail: Blocker.renaldo@mayo.edu.
J Emerg Nurs ■.
0099-1767
Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc.
https://doi.org/10.1016/j.jen.2018.02.001
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to participating nurses to measure workload subjectively and
objectively.
Results: Thirty-eight emergency nurse shifts were observed. A
total of 3,229 interruptions were recorded across 372.5 clinical
hours and 38 shifts (means [M] = 85.0 interruptions per shift,
standard deviation [SD] = 34.9; M = 8.7 interruptions per hour, SD =
3.36). The median duration per interruption was 13.0 seconds. A
moderate positive association was identified between the number
of interruptions experienced during a shift and the increased overall
SURG-TLX workload reported at end-shift, r(36) = 0.323, P = 0.048.
Also, a moderate positive association was identified between
increased reaction times during the RCAT task and increased
mental demand experienced at end of shift, r(36) = 0.460, P b 0.001.
Discussion: This study observed interruptions throughout the
entirety of a nursing shift and found that the majority of
interruptions caused by the environment were low priority.
Targeting interventions to reduce low-priority and environmen-
tal interruptions may aid in alleviating the impact of
interruptions on clinical staff and patient care. Furthermore,
results demonstrate that the frequency of interruptions was
perceived to increase the nursing staff workload overall.
Key words: Human factors; Workload; Workflow interruptions;
Emergency department; Patient safety
Introduction
The emergency department is known for its dynamic work
environment, with unpredictable patients and resulting
events. Most often, the emergency department can be
considered an organized chaos that functions through
frequent interruptions in the workflow. 1 Because patient
visits and service requirements are erratic, they often lead to
interruptions in clinicians’ ongoing care activities. Inter-
ruptions—considered to be any break in the performance of
an activity initiated by a source internal or external to the
recipient and requires the attention of the participant 2 —have
been shown to affect patient satisfaction through decreased
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clinician-patient contact time, increased clinician workload, and
contribution to errors in the ED setting. 3–6 With the impact
that interruptions have in this setting, it is not surprising that the
emergency department has been identified as having the highest
rates of preventable deaths and other adverse events. 7,8
ED physicians are interrupted approximately 11 times
per hour, 9,10 and nurses are not exempt from such challenges
in this setting. One case study performed at a level 1 trauma
center identified that nurses experience more interruptions
than their physician counterparts, 11 yet broader results are
mixed. 12–14 Emergency nurses commonly experience inter-
ruptions during documentation or while preparing patient
medications. 1,15 Consequently, nurses perceive interruptions
and distractions as a primary cause for making errors during
preparation and administration of medication. 16–18
Interruptions are known to have negative effects on
clinician (ie, physicians and nurses) memory, meaning that
interruptions take focus away from the current task. More
specifically, owing to the finite nature of working memory,
interruptions reduce the cognitive resources a clinician can
apply to managing complex requirements of ED care and,
consequently, their ability to remember future intentions. As
a result, frequent interruptions can tax clinicians’ cognitive
workload and increase their risk of committing human error. 1
Commonly, studies have used subjective measures to
understand the impact of interruptions on individuals
without any link to objective measures of workload. 19,20
The Surgery Task Load Index (SURG-TLX) is a 6-item
survey-based tool adapted from the widely used NASA-Task
Load Index (TLX) 21 to measure individual perceptions of
workload in the surgical domain. 22 SURG-TLX is multidi-
mensional and builds upon the mental, physical, and
temporal demand questions from NASA-TLX to include
additional questions consisting of complexity of task,
situational stress, and distractions: factors that contribute to
the overall experience of workload in the operating room.
Reliability and validity testing on NASA-TLX has been
performed in various domains including health care and
aviation (Cronbach’s alpha = 0.63–0.77), 19,20,23–26 whereas
SURG-TLX items have been validated to differentiate
workloads in surgery (ηp 2 = 0.10–0.61). 22 Objective and
psychophysiological measures of workload and performance
have been identified; 27,28 however, most studies have been
limited to laboratory settings. 23 The Rapid Cognitive
Assessment Tool (RCAT), on the other hand, is a motion
accuracy test developed by physiologists and neuropsychologists
to assess cognitive performance during high-altitude mountain
climbs. 29 It evaluates cognitive performance through a
“combination of executive function tasks integrated into a
spawning visual target model.” 30 This was used as part of this
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study, as it was successfully applied outside the laboratory
setting.
Therefore, to better understand how interruptions affect
emergency-nurse workload, this study captured interruption
characteristics (ie, frequency, duration, type, priority, and
location of occurrence) along with subjective (ie, SURG-
TLX) and objective (ie, RCAT) workload measures. This
study aimed to characterize interruptions experienced by
emergency nurses and demonstrate convergence validity of 1
objective workload measure—RCAT—by linking interrup-
tion characteristics to both measures of workload.
Methods
SETTING AND PARTICIPANTS
This observation-based prospective study was performed in an
academic emergency department that is part of a larger
quaternary care center. The emergency department is equipped
with more than 70 patient rooms and 7 resuscitation bays and
has a designated pediatric emergency wing to handle more than
74,000 adult and pediatric patients annually. The Institutional
Review Board (IRB) approved this study.
The research team recruited participants at a monthly
emergency department staff meeting. A presentation was
delivered to attending staff during which the purpose and
importance of the study were discussed. Staff members were
advised that participating in the study would require being
observed during a shift as well as 3 to 5 minutes of their time
at the beginning (for training), middle, and end of their shift
to complete the measures. Participation in the study was
voluntary, and nurses were allowed to opt out at any point
in the study. Shifts for observation were then selected from
the schedules of consented nurses based on observer
availability. Nursing shifts that involved training other
persons were excluded from selection.
RESEARCH PROTOCOL
Data were collected over a 4-month period in 2016.
Emergency nurses were observed throughout their sched-
uled work shifts. At the start of the shift, nurses completed a
training session for the RCAT to familiarize them with the
tool. Nurses then began their work while observers used the
validated WIT 31–33 to track interruption characteristics
over the entirety of the shift. Observers followed nurses as
they interacted with the ED work system, including patient
care. Patients were informed of the study and could opt out
of being observed. Because patients were not considered to
be study participants, IRB deemed that signed consent
forms were not necessary. In those cases, the observer
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FIGURE 1
Snapshot of Rapid Cognitive Assessment Tool (RCAT).
stepped out of the patient room and resumed data collection
when the nurse left the patient room. As mentioned
previously, this study considered an interruption to be “any
break in the performance of a human activity initiated by a
source internal or external to the recipient that very briefly
requires the attention of the participant and does not
inherently necessitate the clinician change tasks.” 2
At the middle and end of shifts, the SURG-TLX and the
RCAT were administered to measure workload. Participants
completed the SURG-TLX questionnaire and rated their self-
perceived levels of mental demand, physical demand, temporal
demand, performance, effort, and frustration on a 20-point
scale. 21 Participants then performed the RCAT task, an
electronic 1-minute game that engages participants in selecting
squares as they appear on the screen (Figure 1). 29 Emergency-
nurse participants were instructed to touch the boxes with a
stylus before they disappeared and to prioritize colored boxes as
they appear. Output from the RCAT included reaction times
and overall performance scores based on the number of correct
versus incorrect boxes touched within a minute.
WORKFLOW INTERRUPTIONS TOOL
Data collection was performed using a tablet PC-based
WIT. The WIT was originally validated in the operating
room setting (87% agreement) 33,34 and then adapted for
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use in the emergency department. 32–34 The WIT allows the
observer to capture interruption characteristics—interrup-
tion type, priority, and location—in real time and to time-
stamp each event. Interruption types included face-to-face
communication with other nurses, physicians, residents,
and various health care professionals; environmental
sounds; pages; phone calls; and unexpected patient requests.
Interruption priority was classified as high, medium, or low
and was identified with respect to the interrupted task.
Examples of interruption type and priority level can be
found in Table 1. To remain unobtrusive, when an
interruption occurred, the observer determined the priority
level by comparing it with the interrupted task and logging
it in the WIT. Interruption locations included staff station,
in patient room, outside patient door, and hallway.
Multiple observers collected interruptions and workload
data over a selected shift to establish reliability in the data-
collection process; 85% agreement between the observers was
reached. The observational team consisted of 3 researchers who
received training in human factors. Training involved learning
to use the WIT, RCAT, and SURG-TLX and observing a shift
together while using the WIT collection tool to identify
interruptions. Observers then separately collected interruption
data for a selected shift, where—upon completion—the
observers compared interruption type and priority coding for
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TABLE 1
Examples of interruption characteristics and priorities experienced by nursing staff

Examples
Type
Face-to-Face Physician Verbal Communication Preparation for an in-room procedure; communication involving
patient status updates and/or discharging patients
Face-to-Face Nurse Verbal Communication Information sharing regarding currently managed patients;
assigning responsibilities for new patients, status/lab updates
Face-to-Face Other Verbal Communication Social work provides updates
Patient transport escort discussions
ECG technician handing off ECGs and rhythm strips
Law enforcement discussion
Environment Alarms
Overhead announcements
Page Resuscitation-team notification
Phone Call Specialty consult calling about a patient
Direct Patient Care Patient and/or patient family member approach staff station
with questions
Other Lost documents
Technology failure (eg, switching pager batteries, software
issues causing delay); dropped procedural equipment and
waiting for replacement
Priority
Low Nurse with a patient and gets interrupted by a nonurgent
page; overhead announcement irrelevant to the emergency
department; redundant updates or communication
Medium Patient presses “call nurse” button for questions or help; patient
updates during EMR entry or alternative patient discharge
High Trauma activation during EMR entry; patient in room needs
immediate attention (survival, behavioral, etc)

ECG = electrocardiograph; EMR = electronic medical record

consistency. Finally, observers discussed any inconsistency performed to identify associations among interruptions,
during the training process. length of shift, and the changes in SURG-TLX and RCAT
workload data.

DATA ANALYSIS
Interruptions and workload data collected using the tablet
PC-based tool were analyzed using IBM SPSS Statistics
(Version 22.0, Armonk, NY) and R-Studio (Version
0.99.489, Boston, MA). Descriptive statistics included
means (M), standard deviations (SD), and medians (Mdn).
Chi-square analyses were performed on the interruption type
and priority data. Paired t-tests were performed on the mid-
and end-shift workload data. Finally, correlations were
Results
Thirty-eight nurses participated in the study, providing 38
observed shifts. Shifts were 8 hours (13/38, 34.2%) or 12
hours (25/38, 65.8%) in length. A majority of participating
emergency nurses were 40 years old or younger (52.6%), had
4 to 15 years of general nursing experience (63.2%), and
had 6 or fewer years of experience as emergency nurses

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70.3 minutes (type: direct patient care). The minimum

TABLE 2
duration was 1.0 second (type: environment). The middle
Emergency nurse participant demographics (N = 38)
50% of interruption durations fell between 5.0 and 33.0
seconds. There was a moderate positive correlation between
n(%)
length of shift and the number of interruptions, r(36) =
Age Range 0.33, P = 0.043, with length of shift explaining 11% of the
25–30 years old 6 (15.8%) variation in the quantity of interruptions. This is logical, as
31–35 years old 6 (15.8%) longer work periods allow more opportunities to experience
36–40 years old 8 (21.1%) interruptions.
41–45 years old 1 (2.6%) At the shift midpoint, emergency nurses reported an
46–50 years old 6 (15.8%) average overall SURG-TLX workload of 48.8 (SD = 16.6).
51–55 years old 1 (2.6%) Task complexity was the highest rated subscale at that time
(M = 11.6, SD = 5.1; Figure 2). At shift end, emergency
56–60 years old 4 (10.5%)
nurses average overall workload increased to 57.3 (SD =
61–65 years old 1 (2.6%)
19.7). All subscale values increased, but task complexity
Preferred not to answer 5 (13.2%) again was the highest rated subscale at end-shift (M = 11.7,
Nurse Experience (Years) SD = 5.4). Significant increases in SURG-TLX subscales at
0–3 years 1 (2.6%) the end of shift included mental demand, t(37) = 3.690, P =
4–6 years 5 (13.2%) 0.001, and situational stress, t(37) = 2.463, P = 0.019.
7–9 years 6 (15.8%) Reaction time and performance data pulled from the RCAT
10–12 years 7 (18.4%) also indicated that reaction time during the task got
13–15 years 6 (15.8%) significantly longer from mid- to end-shift, t(35) = 2.363,
16–18 years 2 (5.3%) P = 0.024, whereas performance scores significantly
19–21 years 2 (5.3%) increased, t(35) = 2.175, P = 0.036.
22–24 years 1 (2.6%) TYPE OF INTERRUPTION
25–27 years 3 (7.9%)
Face-to-face communication with other emergency nurses
28–30 years 1 (2.6%)
accounted for nearly 40% of all interruptions (1,248,
More than 30 years 1 (2.6%)
38.7%), followed by environmental (644, 19.9%), and
Preferred not to answer 3 (7.9%) face-to-face communication with other health care staff (eg,
Emergency Nurse Experience (Years) social workers, patient-care assistants, paramedics;
0–3 years 12 (31.6%) 504,15.6%). Pages and phone calls together accounted for
4–6 years 9 (23.7%) 12% of interruptions (389, 12.0%); face-to-face commu-
7–9 years 7 (18.4%) nication with physicians, residents, and physician assistants
10–12 years 1 (2.6%) (PAs) accounted for 9% of interruptions (273, 8.5%); and
13–15 years 1 (2.6%) unanticipated patient care accounted for the remainder
16-18 years 4 (10.5%) (167, 5.2%).
19–21 years –
22–24 years 1 (2.6%) PRIORITY OF INTERRUPTIONS
Preferred not to answer 3 (7.9%)
Interruptions were most commonly classified as medium/
normal priority (2,087, 64.6%), followed by low (1,073,
33.2%), and high (69, 2.1%) priority. Face-to-face
(55.3%; Table 2). There were no significant differences in communication interruptions were predominately catego-
frequency of interruption based on age or experience (P N rized as medium/normal (nurse, 72.5%; other staff, 71.6%;
0.05). physicians, 82.0%; residents/PAs, 90.7%), whereas envi-
A total of 3,229 interruptions were recorded across ronment (60.2%) and pages (60%) were generally
372.5 clinical hours and 38 shifts (M = 85.0 interruptions categorized as low priority (Figure 3). Chi-square analysis
per shift, SD = 34.9; M = 8.7 interruptions per hour, SD = indicated a significant association between type of inter-
3.36). The median duration per interruption was 13.0 ruption and priority of interruption, χ 2(16) = 669.56, P b
seconds. The maximum duration was 4,219.0 seconds or 0.0001.

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FIGURE 2
Subjective workload subscales collected at mid-shift and end-shift. *P b 0.05

FIGURE 3
Proportions of interruption types by priority.

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TABLE 3
Pearson correlations of SURG-TLX subscales, RCAT outputs, and interruption frequency

Mental Physical Temporal Task Situational Distraction Overall Reaction Performance Interruption
demand demand demand complexity stress difference difference time score quantity
difference difference difference difference difference difference difference
Mental 0.074 0.281 0.037 0.395 * 0.423 † 0.690 † 0.460 † –0.115 0.317
demand
difference
Physical 0.074 0.477 † –0.672 † 0.207 0.519 † 0.518 † 0.061 0.210 0.307
demand
difference
Temporal 0.281 0.477 † –0.593 † 0.619 † 0.789 † 0.801 † 0.165 0.228 0.201
demand
difference
Task 0.037 –0.672 † –0.593 † –0.393 * –0.567 † –0.344 † –0.134 –0.325 –0.168
complexity
difference
Situational 0.395 * 0.207 0.619 † –0.393 * 0.471 † 0.699 † 0.110 0.143 0.176
stress
difference
Distraction 0.423 † 0.519 † 0.789 † –0.567 † 0.471 † 0.814 † 0.259 0.214 0.178
difference
SURG-TLX 0.690 † 0.518 † 0.801 † –0.344 † 0.699 † 0.814 † 0.279 0.097 0.323 *
total
difference
Reaction 0.460 † 0.061 0.165 –0.134 0.110 0.259 0.317 0.010 0.016
time
difference
Performance –0.115 0.210 0.228 –0.325 0.143 0.214 0.307 0.010 0.081
score
difference
Interruption 0.317 0.307 0.201 –0.168 0.176 0.178 0.323 * 0.016 0.081
quantity

SURG-TLX = Surgical Task Load Index; RCAT = Rapid Cognitive Assessment Tool
* Statistically significant at P b 0.05 level
†
Statistically significant at P b 0.001 level

INTERRUPTIONS BY LOCATION WORKLOAD AND INTERRUPTIONS

Interruptions experienced by emergency nurses occurred
most frequently at the staff station (2,333, 72.3%) and in
the patient room (506, 15.7%). At the staff station, nurses
were interrupted by face-to-face communication with
emergency nurses (995/2,333, 42.7%), other health care
staff (336/2333, 14.4%), and environmental sounds (391/
2333, 16.8%). In patient rooms, nurses were interrupted by
environmental sounds (183/506, 36.2%), and face-to-face
communication with emergency nurses (101/506, 20.0%)
and other health care staff (94/506, 18.6%).
Multiple associations were identified within the SURG-
TLX subscales (Table 3). A moderate positive association
was identified between the number of interruptions
experienced during a shift and the increased overall
SURG-TLX workload reported at end-shift, r(36) =
0.323, P = 0.048. In addition, a moderate positive
association was identified between increased reaction
times during the end-shift RCAT task and increased
mental demand reported at end-shift, r(36) = 0.460, P b
0.001.

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Discussion
This study recruited nurses working in the emergency
department at 1 academic institution for the purposes of
identifying interruptions experienced over scheduled work
shifts and correlating their frequency to workload measures.
About a quarter of the nurses recruited were between 25 and
35 years of age and had shifts lasting between 8 hours and
12 hours. Interruptions occurred throughout various areas
of the emergency department, with the frequency of
interruptions observed appropriately related to length of
shift. Correlations among interruptions, subjective, and
objective workloads were identified.
INTERRUPTION CHARACTERISTICS
In this study, emergency nurses experienced 8.7 interrup-
tions per hour on average: much lower than the reported
average of 11 interruptions per hour by emergency
physicians. 9,10 The prevalence of face-to-face communica-
tion interruptions experienced by nurses though were
consistent with the literature. 15 Although the high rate of
face-to-face interruptions with other nurses was expected
from the literature and the ever-changing state of the
emergency department, their occurrence is highly disruptive
to emergency-nurse tasks. The nature of such communica-
tion with other emergency nurses commonly pertained to
patient-status updates and medication requests; a majority
were considered normal priority. This suggests that many of
the communication interruptions were necessary but could
possibly have been mitigated. Future work should examine
how to best manage necessary but nonurgent communica-
tion in this setting.
More than 55% of interruptions that occurred at the
staff station were face-to-face communications with nurses
or other clinicians. In contrast, such interruptions occurred
in the patient rooms only one third of the time. This may
indicate that staff members frequently view the patient
room as a protected space to provide safe patient care but
view the staff station as more of a communications hub.
Next steps should seek to understand the motivations for
interruptions in specific locations throughout the emer-
gency department. In the patient rooms, environmental
interruptions, including alarms and overhead announce-
ments, were most prevalent. Many times, the environ-
mental interruptions were considered low priority and
provided little information to emergency nurses while
they were providing patient care. Scenarios like this, and
the broader concept of alarm fatigue, should be considered
during the design of devices and device-management
systems.
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WORKLOAD AND INTERRUPTIONS
The moderate positive association between interruptions
and the change in workload values at the end of shift
indicates that interruptions may affect nurse perceptions of
workload to some degree. This validates previous findings
linking interruptions to subjective workload measures (eg,
NASA-TLX) with ED physicians. 20,32 Incorporating the
RCAT activity into this study provided the means to
evaluate interruptions against an objective measure of
workload. Although the reaction times and performance
scores collected from the RCAT activity did not correlate to
all SURG-TLX subscales, a moderate positive association
was identified between increased reaction times during the
end-shift RCAT task and increased mental demand
reported by SURG-TLX at end-shift. This indicates
convergent validity between RCAT and the SURG-TLX
mental demand subscale; with future work, the RCAT
could be used as an objective tool to measure clinicians’
mental demands by comparing subsequent reaction times
with a baseline reaction time value. Furthermore, it validates
nurses’ perceptions of increased mental demands through-
out their shifts.
LIMITATIONS
This study is the first study the authors are aware of that
validates the RCAT, an objective workload measure, to 1 or
more of the SURG-TLX subscales. However, the results of
the study must be interpreted in light of several limitations
surrounding observations and generalizability. Data may
have been influenced by the Hawthorne Effect due to the
presence of observers during actual nursing shifts as well as
our previous work examining physician interruptions in the
same setting. 35 Having an emergency nurse perform data
collection may have provided a more clinical perspective on
the content of the communication interruptions and
improved identification of interruption priority. Observers
captured interruption characteristics using the WIT, 33 with
each interruption requiring 7 fields of entry. Short
interruptions or back-to-back interruptions may have
made it difficult to assess priority of the current task or
complete all entry fields accurately. Because priority was
determined at the time of the interruption, it was not
possible to confirm classification with the participating
nurse without causing additional interruptions. However,
our findings generally align with previous work. Further-
more, a power analysis was not performed to validate the
RCAT against the SURG-TLX mental demand subscale,
and only convergent validity was identified. Further
validation work is needed that (1) assesses RCAT against
■ ■ • ■

other validity forms and (2) performs a power analysis to
determine the required number of observations for
validation. It is also important to acknowledge the limiting
generalizability of this study. Although observations were
conducted for shifts across all times of day at 1 institution,
future work should seek to generalize findings by expanding
to multiple sites that experience varying patient volumes in
both academic and community settings.
Implications for Emergency Nurses
Interruptions are pervasive in the emergency department,
meaning that ED nurses not only experience interruptions
but also interrupt others as a means of communication.
Because repeated interruptions can increase the risk of
errors, department managers should involve other clinician
leaders in identifying interventions and procedural changes
to mitigate or eliminate low-priority interruptions. Also,
creating a culture of awareness around interruptions at
inappropriate times may also help reduce unnecessary
distractions.
Conclusions
Interruptions can be a means of communication in the
emergency department. However, results demonstrate that
the frequency of interruptions was perceived to increase the
nursing staff workload overall. Using tools and technology,
such as the RCAT, will enable objective measures of
workload in the future. Furthermore, targeting interven-
tions to reduce low-priority and environmental interrup-
tions may aid in alleviating the impact of interruptions on
clinical staff and patient care.
Acknowledgments
This publication was made possible by funding from the
Mayo Clinic Robert D. and Patricia E. Kern Center for the
Science of Health Care Delivery.
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