Measurement of the frequency and source of interruptions occurring during bedside nursing handover in the intensive care unit: An observational study



      Effective clinical handover involves the communication of relevant patient information from one care provider to another and is critical in ensuring patient safety. Interruptions may contribute to errors and are potentially a significant barrier to the delivery of effective handovers.


      The study objective was to measure the frequency and source of interruptions during intensive care (ICU) bedside nursing handover.


      Twenty observations of bedside handover in an ICU were performed and the frequency and source of interruptions were recorded by the observer for each handover. Observations occurred Monday to Friday during shift change; night to day shift and day to evening shift. Interruptions were defined as a break in performance of an activity.


      The mean handover time was 11 (±4) min with a range of 5–22 min. The mean number of interruptions was 2 (±2) per handover with a range of 0–7. The most frequent number of interruptions was seven, occurring during a 15 min handover. Doctors, nurses and alarming intravenous pumps were the most frequent source of interruptions, with administration staff and wards people also disrupting handovers.


      Nurses, doctors and alarming intravenous pumps frequently interrupt ICU bedside handovers, which may lead to loss of critical information and result in adverse patient events. Increased knowledge in this area will ensure appropriate strategies are developed and implemented in healthcare areas to manage interruptions effectively and improve patient safety.


      To read this article in full you will need to make a payment


        • Spooner A.J.
        • Chaboyer W.
        • Corley A.
        • Hammond N.
        • Fraser J.F.
        Understanding current intensive care unit nursing handover practices.
        Int J Nurs Pract Apr. 2013; 19: 214-220
        • The Joint Commission Center for Transforming Healthcare Organizations
        Improving transitions of care: hand-off communications.
        The Joint Commission Center for Transforming Healthcare Organizations, USA2013
        • World Health Organization
        Patient safety solutions, communications during patient-handovers.
        World Health Organization, Geneva, Switzerland2007
        • Australian Commission on Safety and Quality in Health Care
        National Safety and Quality Health Service Standard. Sydney.
        • Grundgeiger T.
        • Sanderson P.
        Interruptions in healthcare: theoretical views.
        Int J Med Inform. 2009; 78: 293-307
        • Nykolyn L.
        The safety net: a nursing perspective. Effects of fatigue and interruption.
        College of Licensed Practical Nurses of Alberta. CARE Magazine, 2010: 13-15
        • McGillis Hall L.
        • Pedersen C.
        • Fairley L.
        Losing the moment: understanding interruptions to nurses’ work.
        J Nurs Admin. 2010; 40: 169-176
        • Brixey J.J.
        • Robinson D.J.
        • Turley J.P.
        • Zhang J.
        The roles of MDs and RNs as initiators and recipients of interruptions in workflow.
        Int J Med Inform. 2010; 79: e109-e115
        • Brixey J.J.
        • Robinson D.J.
        • Johnson C.W.
        • Johnson T.R.
        • Turley J.P.
        • Zhang J.
        A concept analysis of the phenomenon interruption.
        Adv Nurs Sci. 2007; 30: E26-E42
        • Westbrook J.I.
        • Coiera E.
        • Dunsmuir W.T.
        • Brown B.M.
        • Kelk N.
        • Paoloni R.
        • et al.
        The impact of interruptions on clinical task completion.
        Qual Saf Health Care. 2010; 19: 284-289
        • Speier C.
        • Valacich J.S.I.V.
        The influence of task interruption on individual decision making: an information overload perspective.
        Decis Sci. 1999; 30: 337-360
        • O’Connaill D.
        • Frohlich D.
        Timespace in the workplace: dealing with interruptions.
        in: CHI’95 Mosaic of Creativity. 1995
        • Mark G.
        • Gudith D.
        • Klocke U.
        The cost of interrupted work: more speed and stress.
        Comp. Hum. Interact. 2008; : 107-110
        • Coiera E.
        • Tombs V.
        Communication behaviours in a hospital setting: an observational study.
        BMJ. 1998; 316: 673-676
        • Chisholm C.D.
        • Collison E.K.
        • Nelson D.R.
        • Cordell W.H.
        Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”?.
        Acad Emerg Med. 2000; 7: 1239-1243
        • Gillespie B.M.
        • Chaboyer W.
        • Fairweather N.
        Interruptions and miscommunications in surgery: an observational study.
        AORN J. 2012; 95: 576-590
        • Healey A.N.
        • Sevdalis N.
        • Vincent C.A.
        Measuring intra-operative interference from distraction and interruption observed in the operating theatre.
        Ergonomics. 2006; 49: 589-604
        • Manser T.
        Minding the gaps: moving handover research forward.
        Eur J Anaesthesiol. 2011; 28: 613-615
        • Elliot D.
        • Aitken L.
        • Chaboyer W.
        ACCCN's critical care nursing.
        2nd ed. Mosby, Sydney2012
        • Coiera E.W.
        • Jayasuriya R.A.
        • Hardy J.
        • Bannan A.
        • Thorpe M.E.
        Communication loads on clinical staff in the emergency department.
        Med J Aust. 2002; 176: 415-418
        • Alvarez G.
        • Coiera E.
        Interruptive communication patterns in the intensive care unit ward round.
        Int J Med Inform. 2005; 74: 791-796
        • Centre for Health Redesign
        Safe clinical handover. Key principles for safe clinical handover.
        NSW Health Department, Sydney2009
        • Beyea S.C.
        Distractions, interruptions, and patient safety.
        AORN J. 2007; 86: 109-112
        • Waterworth S.
        • May C.
        • Luker K.
        Clinical “effectiveness” and “interrupted” work.
        Clin Effect Nurs. 1999; : 3
        • Gupta A.
        • Sharda R.
        • Dong Y.
        • Sharda R.
        • Asamoah D.
        • Pickering B.
        Improving rounding in critical care environments through management of interruptions.
        Decis Support Syst. 2013; 55: 423-427
        • Lewis T.
        • Smith C.
        • Williams-Jones P.
        Patient safety: tips to reduce dangerous interruptions by healthcare staff.
        Nursing. 2012; 42: 65-67
        • Clark W.W.
        • Bohne B.A.
        Effects of noise on hearing.
        JAMA. 1999; 281: 1658-1659
        • Hopkinson S.G.
        • Jennings B.M.
        Interruptions during nurses’ work: a state-of-the-science review.
        Res Nurs Health. 2013; 36: 38-53
        • Anthony K.
        • Wiencek C.
        • Bauer C.
        • Daly B.
        • Anthony M.K.
        No interruptions please: impact of a no interruption zone on medication safety in intensive care units.
        Crit Care Nurs. 2010; 30: 21-29
      1. A wake-up call for nurses: sleep loss, safety, and health.
        2004 (Available from:
        • Patterson E.S.
        • Woods D.D.
        Shift changes, updates, and the on-call architecture in space shuttle mission control.
        Comput Support Coop Work. 2001; 10: 317-346
        • Tomietto M.
        • Sartor A.
        • Mazzocoli E.
        • Palese A.
        Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions.
        J Nurs Manag. 2012; 20: 335-343
        • Scott J.
        • Williams D.
        • Ingram J.
        • Mackenzie F.
        The effectiveness of drug round tabards in reducing incidence of medication errors.
        Nurs Times. 2010; 106: 13-15
        • Hopkinson J.B.
        The hidden benefit: the supportive function of the nursing handover for qualified nurses caring for dying people in hospital.
        J Clin Nurs. 2002; 11: 168-175
        • Leonard K.L.
        Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect.
        J Health Econ. 2008; 27: 444-459