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Experienced cognitive load in the emergency department. A prospective study
Yael Appelboom1, Yvonne Groenen2, Dirk Notten3
1Department of Internal Medicine, Zuyderland Medical Centre, Heerlen, Netherlands.
Plos One
|January 17, 2025
Summary
Emergency department residents experience increased mental effort and decreased comfort later in their shifts, particularly from 5 PM onwards. This cognitive load, measured over longer intervals, suggests potential areas for workflow optimization in busy EDs.
Area of Science:
- Emergency Medicine
- Human Factors Engineering
- Medical Education
Background:
- The emergency department (ED) presents a demanding environment for resident physicians due to high patient acuity and a rapid pace.
- Understanding the cognitive load experienced by residents is crucial for ensuring optimal performance and well-being.
Purpose of the Study:
- To investigate the cognitive load experienced by residents working in the emergency department.
- To identify differences in cognitive load throughout a typical workday.
Main Methods:
- A multicentre, prospective study was conducted in three Dutch EDs.
- Residents rated their cognitive load using validated scales for complexity, mental effort, and comfortability.
- Data were collected per decision, 1-hour interval, 2-hour interval, patient, and shift.
Main Results:
- Cognitive load per individual decision was low.
- However, cognitive load increased significantly per 2-hour interval and per shift, indicated by higher mental effort and lower comfortability.
- Mental effort scores began rising from 5 PM, with decreased comfortability noted from 9 PM onwards, peaking between 9 PM and 11 PM.
Conclusions:
- Residents in the ED experience elevated mental effort and reduced comfort from late afternoon onwards, especially during evening hours.
- Cognitive load, particularly mental effort and comfort, is higher when assessed over extended periods (2-hour intervals and shifts) compared to individual decisions.
- Findings suggest opportunities to optimize resident cognitive load through ED workflow and organizational adjustments.
