Doctors’ experiences of interruptions in UK secondary care outpatient clinics: a cross-sectional survey of prevalence, consequences and management strategies

Objectives

To examine the prevalence of interruptions during UK secondary care outpatient consultations, their association with clinician mental workload, and the strategies clinicians use to manage them.

Design

Nationwide cross-sectional online survey.

Setting

Secondary care outpatient clinics, United Kingdom.

Participants

A sample of 465 UK secondary care doctors across a range of grades and specialties, recruited through a medical defence organisation’s network.

Primary and secondary outcome measures

Mental workload (NASA Task Load Index, Raw-TLX); interruption frequency; perceived cognitive impact of interruptions; task resumption difficulty; perceived social effects on colleague interactions and team cohesion; and interruption-management strategy use.

Results

61.1% of clinicians reported being interrupted often or very often, and mean overall workload was high (Raw-TLX 66.2, SD 11.5). Interruption frequency, patient complexity and perceived cognitive impact were each associated with higher workload across multiple NASA-TLX subscales. In fully adjusted models, interruption frequency retained independent associations with overall workload (β = 1.79, p = 0.004) and temporal demand (β = 0.94, p < 0.001). Task resumption difficulty was associated with worse perceived performance (β = −0.59, p = 0.014), while perceiving interruptions as socially positive was associated with better performance (β = 0.75, p = 0.003) and lower frustration (β = −1.16, p < 0.001). Years of experience showed only small effects, and self-reported strategy use (38.7%) was not consistently associated with lower workload. Exploratory natural language processing of open-text descriptions identified three strategy clusters; cognitive offloading, anticipating and preparing, and blunt responses, with distinct emotional profiles.

Conclusions

Interruptions were commonly reported during UK secondary care outpatient consultations and were associated with measurable cognitive and temporal burden. The perceived social framing of interruptions was independently associated with frustration and self-rated performance. Binary strategy use showed no consistent workload association, indicating a need for system-level approaches addressing interruption frequency, task resumption support and the social context of interruptions rather than reliance on individual coping.

Strengths and limitations of this study

• To our knowledge, this is the first national survey of interruptions in UK secondary care outpatient consultations, spanning a wide range of specialties, grades and career stages (0–52 years post-qualification).

• Mental workload was measured using the NASA Task Load Index, a validated multidimensional instrument, allowing workload to be decomposed into cognitive, temporal, physical and affective components.

• Open-text descriptions of interruption-management strategies were analysed using natural language processing, revealing heterogeneity in strategy type that binary coding alone would have obscured.

• The cross-sectional design precludes causal inference, and the direction of the association between perceived interruption frequency and workload cannot be established.

• Recruitment through a single medical defence organisation’s network, together with an indeterminate eligible denominator, means this was a convenience sample in which non-response bias cannot be excluded.