Cited by 449Hospital Admissions and OutcomesPatient Safety and Medication ErrorsElectronic Health Records Systems

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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 L.·2007·International Journal of Medical Informatics

DOI 10.1016/j.ijmedinf.2006.09.019

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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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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.
ORCID: Zhang, Jiajie
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)
DOI: 10.1016/j.ijmedinf.2006.09.019
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: International Journal of Medical Informatics (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. National Library of Medicine (R01 LM07894, R01LM007894)
Topics: Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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

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

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