October ERcast intro: Task Switching

Emergency department multitasking is usually task switching, not true parallel work. When a bolus of chest pain, syncope, and sepsis patients lands at once, throughput depends on how you sequence first orders, bedside evaluation, and charting while protecting attention from constant interruptions.

ED Task Switching Strategies

• Initial order front-loading: A few triage-driven orders placed before first contact can shorten time to labs, imaging, and treatment, especially when vitals already identify obvious high-risk physiology.
• Sickest-first room sequence: A severity-based first pass prioritizes the patient who sounds most unstable, then works down the queue so the highest-acuity problem gets physician attention earliest.
• Round robin workflow: Seeing each patient and entering orders in the room pairs decision-making with immediate action, while deliberately saving the likely time-intensive case for later preserves flow.
• Task stacking approach: Starting the HPI and exam immediately after leaving the room uses fresh working memory, then shifts to the next patient before deep charting consumes the whole batch. We get into the tradeoffs in the episode.
• Disposition-time documentation: One-stop charting at disposition favors a concise MDM-centered note over a long HPI narrative, aiming to reduce repetitive documentation and keep cognitive bandwidth for bedside care.
• Scribe and workstation limits: Available support and room hardware change what is realistic; a scribe or lack of in-room computers can make batch ordering and delayed charting more workable than continuous documentation.

Interruptions and Cognitive Load

• Multitasking is task switching: Cognitive science suggests most ED multitasking is actually rapid switching between tasks, and performance is best when one of those tasks is highly automatic rather than effortful.
• Interruption frequency burden: Emergency clinicians are interrupted roughly 7 to 19 times per hour, a steady assault on working memory that helps explain why seemingly simple workflows break down under load.
• Failure to resume tasks: After an interruption, clinicians do not return to the original task about 62% of the time, a striking number that reframes interruptions as a patient-safety problem, not just an annoyance.
• Ignoring interruptions rarely works: Simply deciding to ignore interruptions is unrealistic in practice; some data suggest clinicians do so less than 5% of the time, so systems and habits matter more than willpower.

References:

1. Skaugset LM, et al. Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine. Ann Emerg Med. 2016 Aug;68(2):189-95. Epub 2015 Nov 14. PMID: 26585046.