For the last eight years my passion has been mobile technology for clinicians at the point of care. In 2014, I started investigating the research on cognitive workload including cognitive shifts and stacking, and applying it to how current technology impacts these concepts when applied to the clinician at the point of care.
A couple of definitions:
- Cognitive workload emerges from the interaction between the: (a) requirements of a task, (b) circumstances under which it is performed, (c) skills, behaviors, and perceptions of the worker, and (d) the level of mental resources required of a person at any one time1
- Cognitive shifts (multitasking) are when the clinician must switch their focus from one thing to another.2 For example, when they are working on something for Patient Jones and a Physician stops them in the hallway and asks a question about Patient Smith.
- Cognitive stacking is the number of activities still needing completion so the clinician must remember them.
A quick peak at what the data tells us about nursing practice:
- Interrupted an average of every 6 minutes and multitasking 34% of the time3
- Cognitive shifts occur every 11-13 minutes on average2,4
- Average cognitive stacking load is 15 tasks, and the range is 11-21 tasks2
Unfortunately, for the most part, much of our technology is not designed to support cognitive workload simply because clinicians do not sit in front of their computer, they are out with their patients. A summary report from the Agency for Healthcare Research and Quality (AHRQ) found:
“Evaluations of the impact of health IT on quality and safety show mixed results, however. The main reasons seems to be a lack of integration of health IT into clinical workflow in a way that supports the cognitive work of the clinician and the workflows among organizations.”5
1. Hart, S.G. & Staveland, L.E. (1988). “Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research,” in Human Mental Workload, P.A. Handcock & N. Meshkati (Eds.), Elsevier.
2. Potter, P., Wolf, L., Boxerman, S., Grayson, D., Sledge, J., Dunagan, C., & Evanoff, B. (2005). An Analysis of Nurses’ Cognitive Work: A New Perspective for Understanding Medical Errors. In J. B. Battles, E. O. Marks & D. Lewin (Eds.), Advances in Patient Safety: From Research to Implementation (AHRQ publication 05-0021-1 ed., Vol. 1). Rockville, MD: Agency for Healthcare Research and Quality Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK20475/?report=printable.
3. Kalisch B.J. & Aebersold, M. Jt Comm J Qual Patient Saf. 2010 Mar;36(3):126-32.
4. Tucker, A. & Spear, S. (2006) Operational Failures and Interruptions in Hospital Nursing, Health Serv Res. Jun 2006; 41(3 Pt 1): 643-662.