Extraneous Load, Patient Census, and Patient Acuity Correlate With Cognitive Load During ICU Rounds

Abstract

BackgroundCognitive Load Theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of intensive care unit (ICU) rounds, when multidisciplinary providers integrate complex decision-making and teaching in a noisy, high-stress environment prone to cognitive distractions. Research QuestionWhat features of ICU rounds correlate with high provider cognitive load? Study Design and MethodsThis was an observational, multisite study of multidisciplinary providers during ICU rounds. Investigators recorded rounding characteristics and hourly extraneous cognitive load events during rounds (defined as distractions, episodes of split-attention or repetition, and deviations from standard communication format). Following rounds, investigators measured each provider’s cognitive load using the Provider Task Load (PTL), an instrument derived from the NASA Task Load Index survey that assesses perceived workload associated with complex tasks. Relationships between rounding characteristics, extraneous load, and PTL score were evaluated using mixed-effects modeling. Results76 providers were observed during 32 rounds from December 2020 – May 2021. The mean (±standard deviation) rounding census was 12.5±2.9 patients. The mean rounding time was 2h17m±49m. The mean extraneous load was 20.5±4.5 events per hour, or one event every 2m51sec. This included 8.6±3.4 distractions, 8.2±4.2 communication deviations, 1.9±1.4 repetitions, and 1.8±1.3 episodes of split-attention per hour. Controlling for covariates, the hourly extraneous load events, number of new patients, and number of higher acuity patients were each associated with increased PTL score (slope: 2.40 and 95% CI: 0.76 – 4.04, slope: 5.23 and 95% CI: 2.02 – 8.43, slope: 3.35 and 95% CI: 1.34 – 5.35, respectively). InterpretationIncreased extraneous load, new patients, and patient acuity were associated with higher cognitive load during ICU rounds. These results can help direct how the ICU rounding structure may be modified to reduce workload and optimize provider learning and performance.