Interruptions in the wild: Development of a sociotechnical systems model of interruptions in the emergency department through a systematic review

• A review and synthesis of the literature on interruptions in the ED was conducted.
• Gaps were identified in conceptualizing sociotechnical system factors of interruptions.
• Although interruption outcomes were noted, few were measured.
• A sociotechnical model of interruptions in complex settings is presented.

Interruptions are unavoidable in the “interrupt driven” Emergency Department (ED). A critical review and synthesis of the literature on interruptions in the ED can offer insight into the nature of interruptions in complex real-world environments. Fifteen empirical articles on interruptions in the ED were identified through database searches. Articles were reviewed, critiqued, and synthesized. There was little agreement and several gaps in conceptualizing sociotechnical system factors, process characteristics, and interruption outcomes. While multiple outcomes of interruptions were mentioned, few were measured, and the relationship between multiple outcomes was rarely assessed. Synthesizing the literature and drawing on ergonomic concepts, we present a sociotechnical model of interruptions in complex settings that motivates new directions in research and design. The model conceptualizes interruptions as a process, not a single event, that occurs within and is shaped by an interacting socio-technical system and that results in a variety of interrelated outcomes.