Cognitive Load Demands From Emotionally Challenging Tasks in Emergency Care

The mental effort required to process information is known as cognitive load (CL). Sustained high CL impairs working memory and is associated with poor recall, medical errors, and physician burnout. Traditional sources of CL in the ED include complex tasks; interruptions or distractions; and learning demands. Recent experimental evidence shows that emotional regulation tasks impose substantial CL. Emotionally demanding tasks are endemic in ED care, yet no studies have measured the impact of these tasks on ED clinicians. We hypothesized that emotional demanding activities impose high CL similar to other common ED tasks.

We designed an electronic survey to assess clinicians’ beliefs regarding the CL demands of different clinical tasks. Participants rated the mental effort required for 15 common ED tasks (e.g., patient interviews; electronic health record tasks; procedures; interruptions; teaching), including two emotionally difficult tasks: delivering bad news and responding to angry or dissatisfied patients. Participants used a visual analog scale (VAS) to rate each task from 0 (very low mental effort) to 100 (very high mental effort). Surveys were sent to ED physicians and advanced practice providers who participated in a prior study and expressed interest in future surveys.

We sent 232 email invitations, received 99 responses (43% response rate), and had surveys finished by 92 individuals in 12 states (93% completion rate). The sample was 50% female and 76% physicians (61 attending/staff; 9 residents) with a mean age of 42 years (range 27-68). Of the 15 tasks, the highest VAS scores were reported for “responding to angry or dissatisfied patients” (mean 78.8, 95% confidence interval [CI] [75.1-82.6]) and “delivering bad news” (mean 77.2, 95% CI [72.9, 81.6]). These scores were statistically similar to the third-highest task (“critical patient resuscitation”, mean 77.1, 95% CI [72.3, 81.5]) and were significantly higher than all 12 remaining tasks including intubation (mean 61.4, 95% CI [56.4, 66.4]), prolonged interruptions (mean 55.7, 95% CI [516, 59.8) and clinical documentation (mean 49.6, 95% CI [44.9, 54.2]).

Emotionally demanding tasks produce higher CL burdens than many other complex ED tasks. Future research should examine educational and system-level interventions to mitigate these effects.