, Volume 173, Issue 5, pp 637-645

Hospital paediatricians’ workflow interruptions, performance, and care quality: a unit-based controlled intervention

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Frequent workflow interruptions jeopardise clinicians’ efficiency and quality of clinical care. We sought to determine the effect of a documentation-assistant intervention. Our hypothesis was that the expected decrease of workflow interruptions enhances paediatricians’ performance and simultaneously improves patients’ perceived quality of care.


This was a controlled intervention study with data collected before and after the intervention at a University Children’s Hospital. For the intervention, a documentation assistant was assigned to an inpatient ward. The main outcome measures were workflow interruptions, paediatricians’ performance, as well as patients’ perceived quality of care. Workflow interruptions were assessed via standardised expert observations. Paediatricians’ evaluated their performance in terms of productivity, quality, and efficiency. Additionally, standardised patients’ reports on perceived quality of care were collected.


For paediatricians in the intervention ward, workflow interruptions decreased significantly from 5.2 to 3.1 disruption events per working hour (decrease in the control unit was from 3.8 to 3.1). Furthermore, paediatricians reported at follow-up significantly enhanced productivity, quality, and efficiency. Similarly, patients’ ratings of care quality improved significantly over time. In multivariate analyses, we found substantial changes attributable to the intervention: for all three outcomes, we found a significant interaction effect of the intervention over study time.


The intervention streamlined paediatricians’ workflow, improved day-to-day functioning of the ward, and enhanced organisational efficiency and delivery of paediatric care. Future studies should investigate potential influences between the reduction of workflow interruptions, paediatricians’ perceived performance, and patient-related outcomes in quality and efficiency of paediatric care.