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A Cognitive Paradigm to Investigate Interference in Working Memory by Distractions and Interruptions
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Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory
Johanna I Westbrook1, Magdalena Z Raban1, Scott R Walter1
1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
BMJ Quality & Safety
|January 11, 2018
Summary
Interruptions and multitasking significantly increase emergency physician prescribing errors. Poor sleep also elevates risks, while working memory capacity offers some protection. These findings highlight safety concerns in dynamic clinical settings.
Area of Science:
- Medical error research
- Human factors in healthcare
- Clinical workflow analysis
Background:
- Experimental studies show interruptions and multitasking impair task performance.
- Clinicians frequently engage in these behaviors in demanding environments.
- The impact on clinical practice, particularly prescribing, is understudied.
Purpose of the Study:
- To quantify the impact of interruptions and multitasking on emergency physician prescribing errors.
- To assess the role of sleep and working memory capacity in these errors.
Main Methods:
- Observational study of 36 emergency physicians over 120 hours.
- Recording of tasks, interruptions, and multitasking instances.
- Assessment of working memory capacity (WMC) and sleep quality; analysis of prescribing errors.
Main Results:
- Physicians experienced high rates of interruptions (7.9/hour) and multitasking while prescribing.
- Interruptions (RR 2.82) and multitasking (RR 1.86) significantly increased prescribing errors.
- Poor sleep was linked to a >15-fold increase in error rates (RR 16.44); higher WMC reduced errors.
Conclusions:
- Interruptions, multitasking, and poor sleep are associated with increased prescribing errors in emergency medicine.
- Working memory capacity partially mitigates these risks.
- High rates of interruption and multitasking in clinical settings warrant re-evaluation for patient safety.
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