# Interruptions and multitasking in anaesthesia nursing: a prospective observational study of cognitive strain and workflow patterns

## TL;DR

This study observes anaesthesia nurses to understand how interruptions and multitasking affect their workflow and stress levels during critical patient care.

## Contribution

The study provides empirical data on multitasking and interruptions in anaesthesia nursing and links them to perceived stress and error risk.

## Key findings

- Interruptions and secondary activities accounted for 12.5% of observed time, with communication being the most frequent interruption type.
- A strong positive correlation was found between perceived stress and perceived error potential among anaesthesia nurses.
- Primary clinical tasks dominated the workflow, with preparatory work making up over half of these tasks.

## Abstract

In critical fields such as anaesthesiology, maintaining uninterrupted focus during key procedures, particularly during critical phases of anaesthesia care, such as induction and extubation, is crucial for patient safety. Multitasking and interruptions in healthcare settings have been linked to increased error rates and reduced efficiency. This study comprises two parts: (1) an objective observational analysis of multitasking and interruptions and (2) an exploratory examination of their relationship to perceived work-related stress, perceived error risk and job satisfaction.

In this prospective observational study, 19 anaesthesia nurses at the University Hospital in Würzburg were observed during 30 field sessions. The study used the Work Observation Method by Activity Timing application for real-time recording and classification of tasks into primary activities (core clinical tasks), secondary activities (parallel tasks, ie, multitasking) and interruptions (externally triggered interruptions leading to task cessation). Spearman’s rank correlation coefficients were calculated to examine associations between observational data and subjective ratings.

Interruptions accounted for 4% of the total observation time, with secondary activities being performed during 8.5% of the time. The average duration of interruptions was 36 s. Primary activities constituted 74.36% of all tasks, with communication-related interruptions being the most frequent. Preparatory work comprised more than half of the total duration of primary activities. Communication tasks were the dominant event during secondary activities, with a significant number of steps associated with them. On a subjective level, a strong positive correlation was found between perceived stress and error potential.

Interruptions and secondary activities were common in anaesthesia nursing workflows but accounted for only a small proportion of total working time. Most interruptions involved communication required for perioperative coordination. Step-based movement estimates showed substantial physical workload, with walking activity unevenly distributed across task categories and predominantly occurring during primary activities.