Emergency Clinicians’ Perceived Consequences of High Cognitive Load on Patient Care

ED clinicians experience cognitive load (CL) from job-related tasks and interruptions. When CL exceeds the limited capacity of working memory, individuals display poor recall and impaired reasoning (“cognitive overload”); this phenomenon is implicated in medical errors. We are aware of no studies examining the ED clinicians’ perceptions of cognitive overload or how it impacts their performance. Since experience attenuated CL through established mental schemas, we hypothesized that clinicians with more experience report fewer CL-related performance impairments than newer clinicians.

We designed an electronic survey to assess clinicians’ beliefs on CL and job performance. Participants rated the impact of high CL on different tasks (e.g., overall performance; diagnosis; treatment; patient communication) using a visual analog scale (VAS) from -100 (much worse) to 100 (much better). Participants estimated the percentage of ED shifts in which CL was high enough to cause these effects. Surveys were sent to ED physicians and advanced practice providers who participated in a prior study and expressed interest in future surveys.

Out of 232 invitations, respondents started 99 surveys (43%) and completed 92 (93%). The sample had respondents from 12 states and included 50% females and 76% physicians. The mean length of experience (e.g., after training) was 11.2 years and was dichotomized (<11 years vs. 11+ years) for analysis. Respondents perceived that high CL reduced quality of all aspects of care, including but not limited to initial assessment (mean -46.5, 95% confidence interval [CI] [-42.3, -25.8]), diagnosis (mean -29.5, 95% CI [-35, -23.9]), and treatment (mean -26.1, 95% CI [-31.7, -20.5]). These results did not differ by experience or role. However, experienced clinicians perceived that these harms occurred in a higher percentage of shifts, including adverse effects on diagnosis (mean difference 10.2% of shifts, 95% CI [1.9, 18.5%], p = 0.016), treatment (mean difference 12.9%, 95% CI [3.2, 22.6%], p = 0.01), and patient communication (mean difference 21.8%, 95% CI [10.9, 32.6], p = 0.0001).

ED clinicians perceive that high CL adversely impacts many aspects of patient care. Experienced clinicians perceive that these harms occur more often than newer clinicians do. Future research should quantify these exposures and outcomes using prospective methods.