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

Abstract

Background: Complex and inefficient information and task organization contribute to high cognitive load for clinicians in interhospital transfer (IHT) care. High cognitive load can lead to medical errors and clinician stress.

Objective: Our study aims to highlight areas of high cognitive load experienced by hospital medicine physicians and advanced practice providers who care for IHT patients.

Methods: Descriptive qualitative study using 1-h semi-structured interviews with hospital medicine clinicians at an academic medical center. We conducted thematic analysis using a combined inductive and deductive coding approach until saturation was achieved.

Results: We interviewed 30 hospital medicine clinicians including 17 physicians (57%) and 13 advanced practice providers (43%) with 1-18 years of experience (mean 5.7 years). Participants identified multiple contributors to cognitive load for clinicians involved in IHTs. Some of these contributors, such as case complexity and time constraints, were fixed, while others, such as task switching, information synthesis burdens, and poor relational trust were seen as potentially modifiable. Participants suggested that (1) creating a single IHT workflow to minimize distractions, (2) streamlining information presentation to optimize information synthesis, and (3) facilitating trust building between healthcare team members as potential solutions to reducing cognitive load.

Conclusions: Physicians and advanced practice providers at an academic medical center experienced increased cognitive load in IHTs when faced with frequent task switching, inefficient delivery of clinical information, and variable levels of trust between healthcare team members. Addressing cognitive load experienced by clinicians in IHTs may lead to safer IHT care and lower risk of clinician burnout.