A 5-Point Communication Strategy to Help Reduce Clinicians’ Cognitive Load
Between 250,000 and 440,000 people die each year from medical errors in the U.S., where medical errors are the third leading cause of death.[i] Distraction has been shown to play a role in nearly 75 percent of medical errors, and studies have demonstrated that cognitive overload is a cause in 80 percent of medical device user errors.[ii] [iii]
A survey Vocera® conducted at HIMSS19 with HIMSS Analytics, whose market research offering is now a part of Definitive Healthcare, points to the prevalence of cognitive overload.[iv] A vast majority of clinical and IT leaders have recognized signs including clinicians appearing stressed or overwhelmed. More than half of survey respondents said clinicians ignore or fail to notice actionable alerts, which are alerts related to a patient’s condition or care.
How cognitive overload can lead to medical errors
We humans parse and make sense of what is going on around us through the act of segmenting. Clinicians in a hospital environment constantly segment what is important and urgent as they perform ongoing triage among shifting priorities. When clinicians receive too many pieces of information at once, they become overloaded, and it becomes difficult to segment and to focus on critical patient care tasks. This is where mistakes can happen.
How hospitals can solve these challenges: a 5-point communication strategy
A hospital that’s standardized on a single clinical communication and collaboration (CC&C) platform for all clinicians is positioned to employ strategies to address cognitive overload. Hospitals need to offload clinicians’ need to retrieve, retain, and record information, and make it easier to communicate. A comprehensive CC&C platform can make all the difference.
With a comprehensive CC&C platform in place, hospitals can take five key measures to reduce cognitive load, which I describe below.
1. Contextualize information
Clinicians are often put in the position of having to solve complex problems without full context. A clinician might have a small piece of standalone information, such as a lab value, but be unable to slot that information into any file system in his or her head that makes sense.
A strategy for countering this challenge is to enable patient information to be attached to the patient’s record so clinicians can access it easily. To the profile of a patient who is the focus of a notification or request, attach an information chain of relevant context including vital signs, lab values, nurse-call information, and other data such as sepsis risk indicators.
2. Deflect distractions to allow focus on critical tasks
It is common for a clinician’s attention to be split among multiple information sources as he or she tries to process many details at the same time. This can lead to cognitive overload and leave the clinician unable to focus on a critical task.
Select communication technology that allows a user to put his or her mobile device on Do Not Disturb mode and divert extraneous information into voicemail, so the user’s status is visible to team members. Make sure a caller can break through Do Not Disturb mode when a matter is truly urgent. Enable a user to set options to forward incoming calls to other people in a group and automatically escalate to other groups if no one in the first group is available.
3. Provide a single source of information and standard communication protocols
Clinicians struggle to communicate with each other when they are hindered by barriers such as multiple standards, conflicting protocols, and disparate communication tools. Sorting out what system to use to contact each other is a drain on working memory for nurses and doctors alike.
The solution: Create a standard protocol and consolidated software workflow for communication where all clinicians and ancillary staff can work with the same software, using the same nomenclature.
4. Offload the need to retrieve, retain, and record information
When a clinician must write the same information in three or four different places while juggling details about four to six different patients, he or she is likely to make a mistake. Redundancy of documentation is a huge problem in healthcare.
Enable clinicians to offload the need to retrieve, retain, and record certain types of information so they don’t need to carry information in short-term memory. Provide a single source of aggregated information that is accessible to the entire care team and doesn’t need to be replicated again and again.
5. Weed out extraneous information
Weeding refers to removing extraneous information from the conversation. With weeding, what is removed is as important as what is allowed through.
Perhaps a nurse doesn’t need to receive a patient’s vital signs every 15-30 minutes if a patient is stable or be notified when a patient’s SpO2 has dropped down to 88% if the patient normally sats at 88%.
Choose a CC&C platform that allows nuisance secondary alert and alarm notifications to be filtered out, so clinicians receive only the information on which they need to act.
Creating a safer, more effective work environment
Clinicians cannot control the amount of information coming at them, nor how it is delivered. If you apply the right tools to help structure information, to offload the need to retain and replicate information, and to weed out nuisance interruptions, you will help reduce the cognitive burden.
Reducing the cognitive burden helps create a more satisfying work environment and fosters well-being and retention. It allows clinicians to function in a more aware and present domain so they can provide a better experience and outcomes for patients.
Read the CNO Perspective report to learn more
Would you like to learn more about why cognitive overload happens, how to recognize its telltale signs in your staff, and how can you apply strategies for reducing it to drive better outcomes? Read my CNO Perspective report: Cognitive Overload, Medical Errors, and a 5-Point Communication Strategy to Help Clinicians Stay Focused.
About the Author: Rhonda Collins, DNP, RN, Chief Nursing Officer at Vocera
[i] Sipherd, Ray. “The third-leading cause of death in US most doctors don't want you to know about.” CNBC.com, 28 Feb 2018, https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-de....
[iii] Faiola, Anthony, PhD MFA; Srinivas, Preethi, PhDc MS; Duke, Jon, MD MS. “Supporting Clinical Cognition: A Human-Centered Approach to a Novel ICU Information Visualization Dashboard.” AMIA Annual Symposium Proceedings Archive, National Center for Biotechnology Information, 5 Nov 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765655/.