Are You Paying Attention? Related Guidance on How Concepts of Attention May Inform Effective Time Sharing of Tasks in Emergency Medicine

Abstract

We read with interest “Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine”1Skaugset M.L. Farrell S. Carney M. et al.Can you multitask? Evidence and limitations of task switching and multitasking in emergency medicine.Ann Emerg Med. 2017; 69: 189-195Abstract Full Text Full Text PDF Google Scholar and we found it to be an important overview relevant to the work of emergency physicians. An improved understanding of multitasking (more appropriately, “time sharing” of tasks) and task switching will help emergency physicians provide safer patient care in the emergency department (ED). The authors accurately acknowledge that task switching in emergency medicine is often unavoidable, so the specialty will benefit by the identification and implementation of strategies for effective task switching. In describing mechanisms for efficient task switching, it is also important to discuss the concept of attention or how our mind best shares attention between different tasks. In this letter, we want to introduce the concept of attention, provide examples of tasks that can be most safely and effectively time shared, and note that these principles must be considered in designing tools for the time sharing and rapid switching of tasks necessary in the ED environment. Attention can be described as a finite “supply of mental resources” at one’s disposal for completing cognitive tasks.2Wickens C.D. Attention.in: The Oxford Handbook of Cognitive Engineering. Oxford University Press, Oxford, UK2013Crossref Google Scholar There are important considerations for how this supply of attention can be shared between different tasks, which have both training and design implications. Here, we provide 3 examples of how understanding concepts about attention may be used to develop operational habits. First, there is a distinction between the mental resources used to perceive and store information (eg, reading and understanding vital signs) versus the resources used to make and act on decisions (eg, decide course of action and submit orders).3Wickens C.D. Multiple resources and mental workload.Hum Factors. 2008; 50: 449-455Crossref PubMed Scopus (1109) Google Scholar This means that listening to sign-out information while writing orders is more efficient than trying to make a disposition decision while writing orders. Second, the ability to share attention between tasks is also affected by the modality (visual versus auditory) of the stimulus (input information) and response (output action).3Wickens C.D. Multiple resources and mental workload.Hum Factors. 2008; 50: 449-455Crossref PubMed Scopus (1109) Google Scholar This is why a physician may easily write orders while responding to a nurse’s questions, but it would be more difficult for him or her to interact with the computer while examining paper charts. Third, we are most effective when we complete tasks with like stimuli and responses.2Wickens C.D. Attention.in: The Oxford Handbook of Cognitive Engineering. Oxford University Press, Oxford, UK2013Crossref Google Scholar For example, physicians are effective in taking visual information from a patient chart and transcribing it into their clinical documentation, whereas visually reviewing this information while having to verbally describe the patient history to someone would result in less efficient time sharing. The authors provide a thoughtful introduction to the importance of teaching effective task switching in emergency medicine. With a better understanding of attentional resources, we can improve emergency physicians’ ability to effectively share time between competing tasks by training, tools, and decision support that promote safe, effective task switching and time sharing. The design of training initiatives, tools, and decision support, such as information systems, should consider the points in regard to task switching highlighted by the authors, as well as the concepts of attention and effective time sharing presented here. Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency MedicineAnnals of Emergency MedicineVol. 68Issue 2PreviewEmergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines—including cognitive science, human factors engineering, business, and medicine—to define and describe the successful performance of task switching and multitasking in emergency medicine. Full-Text PDF In reply:Annals of Emergency MedicineVol. 69Issue 5PreviewWe thank Ms. Benda and Dr. Fairbanks for their interest in our work. Full-Text PDF