Experienced cognitive load in the emergency department. A prospective study

Background and importance The emergency department (ED) is a hectic place, where many critically ill patients are treated. For residents working in the ED, this environment may be demanding. Objectives The aim of this study was to investigate the [1] cognitive load experienced by residents working in the ED, and [2] differences in cognitive load during the day. Methods In this multicentre, prospective study in three EDs in the Netherlands, the experienced cognitive load was graded by residents on three scales, agreed upon during Delphi meetings: the complexity (low-high: 1–3), mental effort (low-high: 1–9) and comfortability scale (low-high: 0–100%). We applied the scores per decision, 1-hour and 2-hour intervals, patient and shift. Main results We observed 14 residents and analysed 74 1-hour and 45 2-hour intervals, 79 patients, 24 shifts and 592 separate decisions. The experienced cognitive load per decision was low. In contrast, the cognitive load was higher per 2-hour interval (mental effort: median 4.0 (IQR 4.0) and comfortability 80% (IQR 20)) and per shift (mental effort: median 5.5 (IQR 4.0) and comfortability 80% (IQR 20). Complexity was low for all measurements. Mental effort rose from 17h onwards higher values, whereas a decrease in comfortability was seen from 21h onwards. Conclusion From 17h onwards, residents working in the ED experienced rather high mental effort and reported feeling not optimally comfortable when making decisions. The mental effort was highest between 21-23h. This was found when cognitive load was measured per 2-hour interval and per shift, but not per decision. This study may provide an insights to optimise cognitive load by reorganisation of the ED.