Interruptions in Healthcare: What This Landmark Study Reveals About Workflow, Safety, and Staff Efficiency

March 12, 2026 | Varsha Chaugai

In healthcare, interruptions are everywhere: a colleague asks a question mid-procedure, a phone rings during charting, or a family member calls looking for an update. While some of these interruptions are necessary, others derail focus, delay tasks, and create risk.

The study "Interruptions and Distractions in Healthcare: Review and Reappraisal" by Rivera and Karsh (published in Quality and Safety in Health Care) is one of the most cited and comprehensive investigations into this issue. It offers a systematic review of how interruptions affect healthcare professionals, particularly nurses, and why not all interruptions are equal.

1. Not All Interruptions Are Harmful, But Many Are Mismanaged

   One of the most important findings is that interruptions in healthcare can be both beneficial and detrimental. For example, a timely reminder from a colleague about a critical medication is helpful. But a non-urgent request during medication administration can increase error rates.

   The authors note that interruptions are context-dependent, their impact varies based on timing, task complexity, and the role of the clinician involved.

2. Interruptions During High-Risk Tasks Lead to Errors

   The study highlights that interruptions during tasks like medication administration or electronic documentation significantly raise the likelihood of error. Even brief distractions create "resumption lags," making it harder for clinicians to pick up exactly where they left off.

   This has serious implications for nurses in long-term care, where medication passes often occur in high-traffic, low-staff environments.

3. Interruptions Create Cognitive Overload

   Frequent task-switching, especially when caused by unplanned interruptions, can lead to mental fatigue, delayed task completion, and decision-making errors. The study categorizes this as a cognitive load problem, not just a time management issue.

4. Healthcare Systems Lack a Strategy for Managing Interruptions

   Despite their frequency and potential harm, most healthcare settings lack standardized protocols for managing interruptions. Rivera and Karsh call for a sociotechnical systems approach, rethinking workflows, environment design, and communication tools together rather than in isolation.

Long-term care communities present a unique communication and workflow environment, one that makes nurses especially vulnerable to interruption-related risks. While acute care environments may deal with fast-paced, episodic care, LTC nurses manage chronic care, daily routines, emotional support, and frequent communication with families all simultaneously.

Here's how these interruptions manifest on the ground:

1. Open Environments Where Nurses Are Highly Visible and Accessible

   Unlike hospitals with private rooms and designated nursing stations, many LTC communities are designed to be open and home-like. While this supports resident independence and socialization, it also means nurses are constantly visible and interruptible, by families, residents, dietary staff, maintenance, or fellow clinicians. There are few physical or social cues to signal "do not disturb," even during medication passes or documentation.

2. Frequent Family Calls or Drop-In Requests for Updates

   Because residents often stay for months or years, families form strong bonds with staff—but this closeness can blur boundaries. Families may feel entitled to immediate updates and often call or visit during the busiest times. Without a structured communication system, nurses are left to handle these inquiries ad hoc, pulling them away from clinical tasks and forcing them to recall detailed information without preparation.

3. Multitasking Across Documentation, Wound Care, and Medication Administration

   LTC nurses manage diverse responsibilities in a single shift: from pressure injury care to behavioral documentation, from controlled medication passes to mealtime oversight. These overlapping tasks create a high cognitive load. Each interruption, whether a quick question or a phone call, forces the nurse to mentally switch tasks, increasing the likelihood of forgetting a step, mischarting a dose, or skipping a follow-up.

Despite these risks, most LTC communities lack formal protocols to reduce interruptions. There are few protected hours for uninterrupted charting or med passes. Family communication is often manual, unstructured, and undocumented, relying on staff availability rather than systematized outreach.

The result? A cascade of downstream consequences:

• Increased Risk of Medication Errors. Studies consistently show that interruptions during medication administration are linked to wrong doses, missed medications, or documentation gaps. For residents on complex regimens (e.g., insulin, anticoagulants, psychotropics), the risk is even higher.
• Higher Cognitive Strain and Burnout. When nurses are interrupted frequently, especially during critical thinking tasks, it leads to decision fatigue, frustration, and mental exhaustion. Over time, this contributes to low morale, increased turnover, and reduced engagement in quality improvement initiatives.
• Delays in Documentation or Missed Charting Windows. Charting is often pushed to the end of a shift or done under time pressure. Interruptions delay documentation, and in some cases, lead to late or missed entries, jeopardizing both compliance and continuity of care.
• Frustration with Families Due to Fragmented Communication. When communication relies on memory and phone tag, families receive inconsistent or delayed updates, leading to dissatisfaction, mistrust, and an increased likelihood of complaints. This erodes the nurse-family relationship and places added emotional labor on staff.

Based on Rivera and Karsh's findings, long-term care communities can implement these evidence-backed practices:

• Design "No Interruption Zones" or "Medication Pass Hours": Visibly signal to staff and families that nurses should not be interrupted during critical tasks.
• Introduce Structured Family Communication Tools: Reduce unscheduled family calls or visits by giving them access to routine updates asynchronously via a portal (like Engage⁺)
• Audit and Redesign Workflow Interruptions: Map out when and where interruptions are most common and create workflows to absorb or redirect them appropriately.
• Train Staff on the Difference Between Necessary and Disruptive Interruptions: Teach clinical and non-clinical staff how to recognize when to escalate a concern and when to wait.
• Use Technology to Centralize Communication: Replace hallway conversations, sticky notes, and phone tag with centralized communication systems that log, track, and time-stamp updates.

Interruptions in long-term care are not just workflow issues, they're clinical and communication risks that require systemic solutions. That's where Engage⁺  fits in.

Engage⁺ is a digital family communication portal purpose-built for long-term care communities. It's designed not to add another system to manage, but to offload routine, repetitive, and high-volume communication tasks from nurses without compromising transparency or trust.

Here's how it directly addresses the challenges outlined above:

1. Reduces Visibility-Based Interruptions

Because families can log in and view health updates (e.g., vitals, new medications, recent fall notes, upcoming appointments), nurses aren't constantly approached during rounds or in hallways for verbal updates. The portal gives families independent access to the information they most frequently request.

Result: Nurses remain focused on care without being pulled aside for non-urgent questions.

2. Transforms Family Communication from Reactive to Proactive

   With Engage⁺, care teams can schedule outbound updates (e.g., newsletters, mass notifications, or care summaries), instead of fielding inbound calls all day. Families know when and how they'll receive information, reducing random call volume.

   Result: Fewer mid-shift interruptions, clearer expectations, and less escalation from families feeling "out of the loop."

3. Creates a Central Record of All Communication

   Every message, consent form, and notification is logged and time-stamped, reducing reliance on verbal exchanges and sticky notes. This creates audit-ready documentation that supports compliance and limits "he said/she said" situations.

   Result: Better handovers, stronger accountability, and less time spent repeating or clarifying previous updates.

4. Gives Nurses Their Time and Focus Back

   In communities using Engage⁺, nurses report spending up to 50% less time on phone calls with families. That's time redirected to care delivery, documentation, and resident engagement without sacrificing family satisfaction.

   Result: Lower cognitive strain, improved job satisfaction, and more time for direct care tasks.

Interruptions in long-term care aren't just annoying; they're a safety risk, a compliance liability, and a driver of nurse burnout. From medication errors and documentation delays to family dissatisfaction and mental fatigue, the cost of unstructured communication is high—and rising.

But it doesn't have to stay that way.

Nurses need more than extra hands. They need systems that protect their time and focus. Engage⁺ offers exactly that: a modern family communication portal that reduces phone interruptions, structures routine updates, and gives families transparent access to the information they need without pulling nurses away from resident care.

In communities using Engage⁺, staff report up to 50% less time spent on family calls, faster documentation workflows, and improved satisfaction from both families and care teams. It's not about doing more; it's about doing it smarter.

If your team is still managing family communication with voicemails, hallway updates, and handwritten notes, it's time to ask: Is your communication model supporting your care model or standing in the way of it?