Assessing emergency department physician workload: A NASA-TLX analysis by experience and care type

Emergency department (ED) physicians face substantial cognitive and physical demands, yet workload data applicable to real-world staffing and operational decisions remain limited. This study aimed to quantify perceived workload across diverse ED tasks using the NASA Task Load Index (NASA-TLX) and to determine how workload varies by physician experience, patient acuity, and clinical context. A secondary aim was to generate practical insights that may inform resource allocation and experience-based task distribution in the ED.

We conducted an observational survey of interns, residents, and specialists working in the ED of a tertiary hospital between June and July 2022. NASA-TLX questionnaires were administered to assess workload across common procedures and patient-care tasks. Analyses were stratified by physician experience, Korean Triage and Acuity Scale (KTAS) level, and chief complaint. Nonparametric methods were used to evaluate differences in workload patterns.

Sixty physicians participated (30 interns, 30 residents/specialists). Procedures with high technical complexity, such as thoracentesis and lumbar puncture, showed the highest workload among interns. Among residents, workload decreased from postgraduate year 1 to 3 but rose again in year 4, reflecting increased supervisory responsibilities. Higher patient acuity (KTAS 1-2) and neurological chief complaints were consistently associated with elevated workload across all experience levels.

Perceived workload in the ED varies significantly by task type, experience level, and patient acuity. These findings provide actionable data that may support evidence-based staffing decisions, workload redistribution, and training strategies to optimize physician performance and mitigate cognitive overload in resource-limited emergency departments.