Extraneous Load, Patient Census, and Patient Acuity Correlate With Cognitive Load During ICU Rounds

Area of Science:

• Medical Education
• Healthcare Operations
• Cognitive Psychology

Background:

• Cognitive load theory explains how excessive mental effort impairs learning and performance.
• Intensive care unit (ICU) rounds present a high-stress, complex environment with numerous cognitive distractions.
• Multidisciplinary teams in the ICU must balance decision-making, teaching, and patient care amidst these challenges.

Purpose of the Study:

• To identify features of ICU rounds that correlate with high provider cognitive load.
• To investigate the relationship between extraneous cognitive load events and perceived workload during ICU rounds.
• To inform potential modifications of ICU rounding structures to mitigate cognitive burden.

Main Methods:

• An observational, multisite study involving multidisciplinary ICU providers.
• Extraneous cognitive load events (distractions, split-attention, repetition, communication deviations) were recorded hourly.
• Provider cognitive load was measured using the Provider Task Load (PTL) survey, adapted from NASA's Task Load Index.
• Mixed-effects modeling analyzed associations between rounding characteristics, extraneous load, and PTL scores.

Main Results:

• A total of 76 providers participated in 32 ICU rounds.
• The average extraneous cognitive load was 20.5 events per hour (one event every 2 min 51 s).
• Higher hourly extraneous load events, more new patients, and increased patient acuity were significantly associated with elevated PTL scores.

Conclusions:

• Increased extraneous cognitive load, the number of new patients, and patient acuity are key factors contributing to high cognitive load during ICU rounds.
• These findings suggest that modifying ICU rounding structures can help reduce provider workload.
• Optimizing these structures has the potential to improve provider learning and clinical performance.