The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care

Archana Laxmisan, Forogh Hakimzada, Osman R. Sayan, Robert A. Green, Jiajie Zhang, Vimla Patel

Research output: Contribution to journalArticle

248 Citations (Scopus)

Abstract

Several studies have shown that there is information loss during interruptions, and that multitasking creates higher memory load, both of which contribute to medical error. Nowhere is this more critical than in the emergency department (ED), where the emphasis of clinical decision is on the timely evaluation and stabilization of patients. This paper reports on the nature of multitasking and shift change and its implications for patient safety in an adult ED, using the methods of ethnographic observation and interviews. Data were analyzed using grounded theory to study cognition in the context of the work environment. Analysis revealed that interruptions within the ED were prevalent and diverse in nature. On average, there was an interruption every 9 and 14 min for the attending physicians and the residents, respectively. In addition, the workflow analysis showed gaps in information flow due to multitasking and shift changes. Transfer of information began at the point of hand-offs/shift changes and continued through various other activities, such as documentation, consultation, teaching activities and utilization of computer resources. The results show that the nature of the communication process in the ED is complex and cognitively taxing for the clinicians, which can compromise patient safety. The need to tailor existing generic electronic tools to support adaptive processes like multitasking and handoffs in a time-constrained environment is discussed.

Original languageEnglish (US)
Pages (from-to)801-811
Number of pages11
JournalInternational Journal of Medical Informatics
Volume76
Issue number11-12
DOIs
StatePublished - Nov 1 2007
Externally publishedYes

Fingerprint

Emergency Medical Services
Hospital Emergency Service
Decision Making
Patient Safety
Medical Errors
Workflow
Documentation
Cognition
Teaching
Referral and Consultation
Hand
Communication
Observation
Interviews
Physicians

Keywords

  • Cognition
  • Emergency care information systems
  • Handoffs
  • Interruptions
  • Medical errors
  • Multitasking

ASJC Scopus subject areas

  • Health Informatics

Cite this

The multitasking clinician : Decision-making and cognitive demand during and after team handoffs in emergency care. / Laxmisan, Archana; Hakimzada, Forogh; Sayan, Osman R.; Green, Robert A.; Zhang, Jiajie; Patel, Vimla.

In: International Journal of Medical Informatics, Vol. 76, No. 11-12, 01.11.2007, p. 801-811.

Research output: Contribution to journalArticle

Laxmisan, Archana ; Hakimzada, Forogh ; Sayan, Osman R. ; Green, Robert A. ; Zhang, Jiajie ; Patel, Vimla. / The multitasking clinician : Decision-making and cognitive demand during and after team handoffs in emergency care. In: International Journal of Medical Informatics. 2007 ; Vol. 76, No. 11-12. pp. 801-811.
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