The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care
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.
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The nature of work in the emergency department, where physicians are frequently interrupted, treat multiple patients simultaneously and must regularly prioritize decision-making, places considerable demands on their cognitive resources and thus increases the likelihood of making errors.
“The nature of work in the emergency department, where physicians are frequently interrupted, treat multiple patients simultaneously and must regularly prioritize decision-making, places considerable demands on their cognitive resources and thus increases the likelihood of making errors (Laxmisan et al. 2007).”
From Measuring physician cognitive load: validity evidence for a physiologic and a psychometric tool (2017) · cites this paper as Laxmisan et al. 2007
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- Authors
- Laxmisan, A., Hakimzada, F., Sayan, O. R., Green, R. A., Zhang, J., & Patel, V. L.
- Affiliations
- Columbia University (US)
- NewYork–Presbyterian Hospital (US)
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Patel, Vimla L.
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2007-11
- Volume
- 76
- Issue
- 11-12
- Pages
- 801-811
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W1979128545
- Semantic Scholar
- 8366ab6e09f562ddc55622229db8a4c5cf2143a7
- Cited by
- 449
- References
- 40
- Citations by year
- 2026: 12 · 2025: 23 · 2024: 13 · 2023: 11 · 2022: 18 · 2021: 19 · 2020: 25 · 2019: 28 · 2018: 26 · 2017: 25 · 2016: 33 · 2015: 27 · 2014: 33 · 2013: 39 · 2012: 30
- FWCI
- 15.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. National Library of Medicine (R01 LM07894, R01LM007894)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- multitasking, shift change, interruptions, cognitive demand, clinical decision-making, patient safety, emergency department, information transmission, workflow analysis, memory load, medical errors, electronic health records
- MeSH terms
- Continuity of Patient Care, Decision Making, Emergency Service, Hospital, Humans, Interviews as Topic, Patient Care Team, Patient Transfer, United States, Medical Records Systems, Computerized, Efficiency, Organizational, Observation, Interdisciplinary Communication
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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