Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2021

01-12-2021 | Care | Original research

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Authors: Tobias Augenstein, Anna Schneider, Markus Wehler, Matthias Weigl

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2021

Login to get access

Abstract

Background

Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA).

Methods

Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2).

Results

ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009).

Conclusions

Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.
Appendix
Available only for authorised users
Literature
1.
Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking.”? Acad Emerg Med. 2000;7(11):1239–43.PubMedCrossRef
2.
Raban MZ, Walter SR, Douglas HE, Strumpman D, Mackenzie J, Westbrook JI. Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol. BMJ Open. 2015;5(10):e009076.PubMedPubMedCentralCrossRef
3.
Skaugset LM, Farrell S, Carney M, Wolff M, Santen SA, Perry M, et al. Can you multitask? Evidence and limitations of task switching and multitasking in emergency medicine. Ann Emerg Med. 2016;68(2):189–95.PubMedCrossRef
4.
Ratwani RM, Fong A, Puthumana JS, Hettinger AZ. Emergency physician use of cognitive strategies to manage interruptions. Ann Emerg Med. 2017;70(5):683–7.PubMedCrossRef
5.
Weigl M, Müller A, Sevdalis N, Angerer P. Relationships of multitasking, physicians’ strain, and performance: an observational study in ward physicians. J Patient Saf. 2013;9(1):18–23.PubMed
6.
Chisholm CD, Dornfeld AM, Nelson DR, Cordell WH. Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. Ann Emerg Med. 2001;38(2):146–51.PubMedCrossRef
7.
Westbrook JI, Coiera E, Dunsmuir WT, Brown BM, Kelk N, Paoloni R, et al. The impact of interruptions on clinical task completion. Qual Saf Health Care. 2010;19(4):284–9.PubMedCrossRef
8.
Edwards A, Fitzpatrick L-A, Augustine S, Trzebucki A, Cheng SL, Presseau C, et al. Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings. Int J Med Inform. 2009;78(9):629–37.PubMedCrossRef
9.
Weigl M, Muller A, Zupanc A, Angerer P. Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians. BMC Health Serv Res. 2009;9(1):110.PubMedPubMedCentralCrossRef
10.
Douglas HE, Raban MZ, Walter SR, Westbrook JI. Improving our understanding of multi-tasking in healthcare: drawing together the cognitive psychology and healthcare literature. Appl Ergon. 2017;59(Pt A):45–55.PubMedCrossRef
11.
Fong A, Ratwani RM. Understanding emergency medicine physicians multitasking behaviors around interruptions. Acad Emerg Med. 2018;25(10):1164–8.PubMedCrossRef
12.
Walter SR, Raban MZ, Dunsmuir WTM, Douglas HE, Westbrook JI. Emergency doctors’ strategies to manage competing workload demands in an interruptive environment: an observational workflow time study. Appl Ergon. 2017;58:454–60.PubMedCrossRef
13.
14.
Thomas HA, Beeson MS, Binder LS, Brunett PH, Carter MA, Chisholm CD, et al. The 2005 model of the clinical practice of emergency medicine: the 2007 update. Acad Emerg Med. 2008;15(8):776–9.PubMedCrossRef
15.
Forsberg HH, Athlin ÅM, von Thiele Schwarz U. Nurses’ perceptions of multitasking in the emergency department: effective, fun and unproblematic (at least for me) – a qualitative study. Int Emerg Nurs. 2015;23(2):59–64.PubMedCrossRef
16.
Abdulwahid MA, Booth A, Turner J, Mason SM. Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: a systematic review and critical appraisal of time and motion studies. Emerg Med J. 2018;35(11):692–700.PubMed
17.
Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform. 2007;76(11–12):801–11.PubMedCrossRef
18.
Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart SD. Psychological skills to improve emergency care providers’ performance under stress. Ann Emerg Med. 2017;70(6):884–90.PubMedCrossRef
19.
Chan TM, Mercuri M, Van Dewark K, Sherbino J, Schwartz A, Norman G, et al. Managing multiplicity: conceptualizing physician cognition in multipatient environments. Acad Med. 2018;93(5):786–93.PubMedCrossRef
20.
Wears RL, Perry SJ. Human factors and ergonomics in the emergency department. Ann Emerg Med. 2002;40(2):206–12.PubMedCrossRef
21.
Wears RL, Woloshynowych M, Brown R, Vincent CA. Reflective analysis of safety research in the hospital accident & emergency departments. Appl Ergon. 2010;41(5):695–700.PubMedCrossRef
22.
Nemeth C, Wears RL, Patel S, Rosen G, Cook R. Resilience is not control: healthcare, crisis management, and ICT. Cogn Tech Work. 2011;13(3):189.CrossRef
23.
Hazlehurst B, McMullen CK, Gorman PN. Distributed cognition in the heart room: how situation awareness arises from coordinated communications during cardiac surgery. J Biomed Inform. 2007;40(5):539–51.PubMedCrossRef
24.
25.
Salvucci DD, Taatgen NA. Threaded cognition: an integrated theory of concurrent multitasking. Psychol Rev. 2008;115(1):101–30.PubMedCrossRef
26.
Sweller J. Psychology of learning and motivation. Cogn Load Theory. 2011;55:37–76.
27.
Adler RF, Benbunan-Fich R. Juggling on a high wire: multitasking effects on performance. Int J Hum-Comput St. 2012;70(2):156–68.CrossRef
28.
29.
Flowerdew L, Brown R, Vincent C, Woloshynowych M. Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature. Ann Emerg Med. 2012;59(5):386–94.PubMedCrossRef
30.
Schneider A, Wehler M, Weigl M. Effects of work conditions on provider mental well-being and quality of care: a mixed-methods intervention study in the emergency department. BMC Emerg Med. 2019;19(1):1.PubMedPubMedCentralCrossRef
31.
Weigl M, Müller A, Holland S, Wedel S, Woloshynowych M. Work conditions, mental workload and patient care quality: a multisource study in the emergency department. BMJ Qual Saf. 2016;25(7):499–508.PubMedCrossRef
32.
Weigl M, Haendl T, Wehler M, Schneider A. Beobachtungsstudie arztlicher und pflegerischer Aktivitaten in der Notaufnahme. [Time-allocation study of nurse and physician activities in the emergency department]. Medizinische Klinik, Intensivmedizin und Notfallmedizin. 2020.
33.
Gwet K. Handbook of inter-rater reliability: how to estimate the level of agreement between two or multiple raters. Gaithersburg: STATAXIS Publishing Company; 2001.
34.
Semmer N, Zapf D, Dunckel H. Instrument zur stressbezogenen Tätigkeitsanalyse (ISTA). In: Dunckel H, editor. Handbuch psychologischer Arbeitsanalyseverfahren. Zürich: vdf Hochschulverlag AG. 1999;14:179–204.
35.
Arora S, Tierney T, Sevdalis N, Aggarwal R, Nestel D, Woloshynowych M, et al. The Imperial stress assessment tool (ISAT): a feasible, reliable and valid approach to measuring stress in the operating room. World J Surg. 2010;34(8):1756–63.PubMedCrossRef
36.
Endsley MR. Situation awareness misconceptions and misunderstandings. J Cogn Eng Decis Mak. 2015;9(1):4–32.CrossRef
37.
Endsley MR. Toward a theory of situation awareness in dynamic systems. Hum Factors. 2016;37(1):32–64.CrossRef
38.
Endsley MR. Measurement of situation awareness in dynamic systems. Hum Factors. 2016;37(1):65–84.CrossRef
39.
Walter SR, Li L, Dunsmuir WT, Westbrook JI. Managing competing demands through task-switching and multitasking: a multi-setting observational study of 200 clinicians over 1000 hours. BMJ Qual Saf. 2014;23(3):231–41.PubMedCrossRef
40.
Zijlstra FRH, Roe RA, Leonora AB, Krediet I. Temporal factors in mental work: effects of interrupted activities. J Occup Organ Psychol. 1999;72:163–85.CrossRef
41.
Morrison JB, Rudolph JW. Learning from accident and error: avoiding the hazards of workload, stress, and routine interruptions in the emergency department. Acad Emerg Med. 2011;18(12):1246–54.PubMedPubMedCentralCrossRef
42.
Vincent A, Semmer NK, Becker C, Beck K, Tschan F, Bobst C, et al. Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature. J Crit Care. 2020.
43.
Gaba DM, Howard SK, Small SD. Situation awareness in anesthesiology. Hum Factors. 1995;37(1):20–31.PubMedCrossRef
44.
Wickens CD. Situation awareness: review of mica Endsley's 1995 articles on situation awareness theory and measurement. Hum Factors. 2008;50(3):397–403.PubMedCrossRef
45.
Nugus P, Holdgate A, Fry M, Forero R, McCarthy S, Braithwaite J. Work pressure and patient flow management in the emergency department: findings from an ethnographic study. Acad Emerg Med. 2011;18(10):1045–52.PubMedCrossRef
46.
Reay G, Rankin JA, Then KL. Momentary fitting in a fluid environment: a grounded theory of triage nurse decision making. Int Emerg Nurs. 2016;26:8–13.PubMedCrossRef
47.
Barg-Walkow LH, Thomas RP, Wickens CD, Rogers WA. Modeling task scheduling decisions of emergency department physicians. Hum Factors. 2019;0(0):18720819893427.
48.
Blocker RC, Heaton HA, Forsyth KL, Hawthorne HJ, El-Sherif N, Bellolio MF, et al. Physician, interrupted: workflow interruptions and patient Care in the Emergency Department. J Emerg Med. 2017;53(6):798–804.PubMedCrossRef
49.
Srna S, Schrift RY, Zauberman G. The illusion of multitasking and its positive effect on performance. Psychol Sci. 2018;29(12):1942–55.CrossRef
50.
Peifer C, Zipp G. All at once? The effects of multitasking behavior on flow and subjective performance. Eur J Work Org Psychol. 2019;28(5):682–90.CrossRef
51.
Waller MJ. Preferences, behaviors, and strategies in multiple-task performance. In: Dansereau F, Yammarino FJ, editors. Multi-level issues in organizations and time (research in multi level issues, volume 6): Emerald Group Publishing Limited; 2007. p. 239–47.
52.
KC DS. Does multitasking improve performance? Evidence from the emergency department. Manuf Serv Oper Manag. 2014;16(2):168–83.CrossRef
53.
Schneider A, Williams DJ, Kalynych C, Wehler M, Weigl M. Physicians’ and nurses’ work time allocation and workflow interruptions in emergency departments: a comparative time-motion study across two countries. Emerg Med J. 2020;1:208508.
54.
Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010;170(8):683–90.PubMedCrossRef
55.
Westbrook JI, Raban MZ, Walter SR, Douglas H. Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study. BMJ Qual Saf. 2018;27(8):655–63.PubMedPubMedCentralCrossRef
56.
Monteiro SD, Sherbino JD, Ilgen JS, Dore KL, Wood TJ, Young ME, et al. Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians? Acad Med. 2015;90(4):511–7.PubMedCrossRef
57.
Wickens CD, Gutzwiller RS, Santamaria A. Discrete task switching in overload: a meta-analyses and a model. Int J Hum-Comput St. 2015;79:79–84.CrossRef
58.
Soares WE 3rd, Price LL, Prast B, Tarbox E, Mader TJ, Blanchard R. Accuracy screening for ST elevation myocardial infarction in a task-switching simulation. West J Emerg Med. 2019;20(1):177–84.PubMedCrossRef
59.
Adams TN, Rho JC. Multitasking simulation: present application and future directions. Med Teac. 2017;39(2):120–2.CrossRef
Metadata
Title
Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies
Authors
Tobias Augenstein
Anna Schneider
Markus Wehler
Matthias Weigl
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
DOI
https://doi.org/10.1186/s13049-020-00824-8

Other articles of this Issue 1/2021

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2021 Go to the issue

Original research

The ROX index as a predictor of standard oxygen therapy outcomes in thoracic trauma

Original research

A validity study of the rapid emergency Triage and treatment system for children

Original research

Smartphone apps to support laypersons in bystander CPR are of ambivalent benefit: a controlled trial using medical simulation

Case report

The Great Belt train accident: the emergency medical services response

Original research

Guideline adherence among prehospital emergency nurses when caring for patients with chest pain: a prospective cohort study

Original research

Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care