Interruptions interfere with productivity and efficiency. Moreover, interruptions are linked to serious errors in complex work environments such as aviation, driving, and healthcare [1], [2], [3], [4]. In healthcare, interruptions contribute to missed care or care delays with adverse consequences [3], [4]. Acute care hospital work environments (e.g., emergency, acute care, intensive care, and operating rooms) exemplify the most demanding healthcare settings characterized by complex clinical and administrative activities requiring task switching with frequent interruptions [5], [6]. Although some interruptions may mitigate errors and be essential in communicating task- or patient-related information, disruptive interruptions can also have negative consequences, such as failed or erroneous task resumption. Errors and missed care are unacceptable, including emergency departments (EDs) and intensive care units (ICUs) [2], [5], [7], [8].

In hospitals and primary care facilities, interruptions occur disproportionately in EDs in comparison with non-ICUs [9], [10]. The work environment in the ED is interruption-laden. Patient care is prioritized based on acuity, so if a clinician is caring for a low-acuity patient when a more critical patient arrives, care can be interrupted to care for the patient who requires urgent attention. An unstable trauma patient, for example, will be prioritized over a patient with low back pain. Although interruptions attributed to an unstable condition are reasonable, it is not uncommon for interrupted tasks to be delayed indefinitely or missed altogether [26], [11].

It is crucial to evaluate the state of the science in ED interruptions research to determine what is known, what gaps remain, and where future studies should be directed. Current evidence on interruptions in the ED suggests that interactions among individuals, tasks, technology, and the work environment [12] cannot be fully explained by a linear structure-process-outcomes model [13]. The ED work environment includes task-switching or “multi-tasking” with distractions that are broadly linked to increased risk of cognitive errors; it must be viewed within a framework of systems thinking [14]. The causes and effects of interruptions in the ED merit inquiry to build on previous reviews and integrate critical appraisals from multiple disciplines. The recognition and classification of work environment features affect care delivery. To further advance interruption science to address interruptions prevention and/or management, conceptual and operational definitions as well as study designs are essential. This systematic review aims to describe the operationalization of interruptions measurement and synthesize the evidence on the causes and consequences of interruptions in the ED work environment.