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Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation.

William E Soares1, Lori L Price2, Brendan Prast3

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Task switching during emergency department care did not impact ST-segment elevation myocardial infarction (STEMI) electrocardiogram (ECG) interpretation accuracy. However, accuracy decreased for inferior STEMI and with low confidence when interrupted.

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Medical Simulation

Background:

  • Emergency department (ED) interruptions are linked to clinical errors, impacting patient care.
  • Screening electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) are critical interrupting tasks for emergency physicians (EPs).
  • Task switching, pausing a primary task for an interruption, is a common EP strategy, but its effect on STEMI ECG interpretation accuracy is unknown.

Purpose of the Study:

  • To investigate the impact of task switching on the accuracy of STEMI ECG interpretation by EPs in a simulated environment.
  • To compare STEMI ECG interpretation accuracy between task-switching and uninterrupted workflows.

Main Methods:

  • A crossover simulation trial involving resident and attending EPs.
  • Participants completed both a task-switching simulation (interrupted by clinical tasks, including STEMI ECGs) and an uninterrupted simulation.
  • The primary outcome measured was the accuracy of STEMI ECG interpretation in both conditions.

Main Results:

  • No significant difference in STEMI ECG interpretation accuracy was found between task-switching (0.89) and uninterrupted (0.91) simulations (p=0.21).
  • Attending physician status was associated with higher odds of correct interpretation (OR [2.56]), while inferior STEMI ECGs were associated with lower odds (OR [0.08]).
  • Low self-reported confidence correlated with decreased interpretation accuracy in the task-switching scenario (interaction p=0.02).

Conclusions:

  • Task switching did not significantly affect overall STEMI ECG interpretation accuracy in this simulation.
  • Accuracy was reduced for inferior STEMI ECGs and when physicians reported low confidence during interruptions.
  • Findings suggest a need for targeted ECG training and improved identification of high-risk ECGs in interrupted clinical workflows.