Overloaded: How task switching, information synthesis, and poor relational trust make interhospital transfers...

Area of Science:

• Healthcare Management
• Clinical Operations
• Medical Education

Background:

• Complex information and task organization in interhospital transfers (IHTs) contribute to high clinician cognitive load.
• High cognitive load is linked to medical errors and increased clinician stress.

Purpose of the Study:

• To identify key contributors to cognitive load for hospital medicine physicians and advanced practice providers managing IHT patients.
• To explore potential solutions for mitigating cognitive load in IHT care.

Main Methods:

• A descriptive qualitative study involving 30 hospital medicine clinicians (physicians and advanced practice providers) at an academic medical center.
• Semi-structured interviews (1-hour duration) were conducted.
• Thematic analysis using a combined inductive and deductive coding approach was employed until data saturation.

Main Results:

• Clinicians identified fixed contributors to cognitive load (e.g., case complexity, time constraints) and modifiable ones (e.g., task switching, information synthesis, relational trust).
• Suggested solutions included standardizing IHT workflows, optimizing information presentation, and enhancing team trust.
• Participants included 17 physicians and 13 advanced practice providers with an average of 5.7 years of experience.

Conclusions:

• Frequent task switching, inefficient clinical information delivery, and variable trust levels significantly increase cognitive load for clinicians in IHTs.
• Mitigating cognitive load in IHTs has the potential to enhance patient safety and decrease clinician burnout.