Types of decisions.

Background and importance The emergency department (ED) is a hectic place, where many critically ill patients are treated. For residents working in the ED, this environment may be demanding. Objectives The aim of this study was to investigate the [1] cognitive load experienced by residents working in the ED, and [2] differences in cognitive load during the day. Methods In this multicentre, prospective study in three EDs in the Netherlands, the experienced cognitive load was graded by residents on three scales, agreed upon during Delphi meetings: the complexity (low-high: 1–3), mental effort (low-high: 1–9) and comfortability scale (low-high: 0–100%). We applied the scores per decision, 1-hour and 2-hour intervals, patient and shift. Main results We observed 14 residents and analysed 74 1-hour and 45 2-hour intervals, 79 patients, 24 shifts and 592 separate decisions. The experienced cognitive load per decision was low. In contrast, the cognitive load was higher per 2-hour interval (mental effort: median 4.0 (IQR 4.0) and comfortability 80% (IQR 20)) and per shift (mental effort: median 5.5 (IQR 4.0) and comfortability 80% (IQR 20). Complexity was low for all measurements. Mental effort rose from 17h onwards higher values, whereas a decrease in comfortability was seen from 21h onwards. Conclusion From 17h onwards, residents working in the ED experienced rather high mental effort and reported feeling not optimally comfortable when making decisions. The mental effort was highest between 21-23h. This was found when cognitive load was measured per 2-hour interval and per shift, but not per decision. This study may provide an insights to optimise cognitive load by reorganisation of the ED.研究背景与意义 急诊室（Emergency Department, ED）作为繁忙的医疗一线场所，收治大量危重症患者。对于在急诊室工作的住院医师而言，该工作环境极具挑战性。 研究目的 本研究旨在探究两项内容：[1] 急诊室住院医师所承受的认知负荷，以及[2] 日间认知负荷的差异情况。 研究方法 本研究为一项多中心前瞻性研究，纳入荷兰三家急诊室的住院医师。由住院医师基于德尔菲会议（Delphi meetings）商定的三项量表对自身感知的认知负荷进行分级：复杂度量表（低-高：1~3）、心理负荷量表（低-高：1~9）与舒适度量表（低-高：0~100%）。研究者按单次诊疗决策、1小时时段、2小时时段、患者及班次分别记录评分。 主要研究结果 本研究共纳入14名住院医师，分析了74个1小时时段、45个2小时时段、79例患者、24个班次及592项独立诊疗决策。单次诊疗决策对应的感知认知负荷较低。相较而言，每2小时时段（心理负荷中位数为4.0，四分位距（Interquartile Range, IQR）为4.0；舒适度中位数为80%，四分位距为20）与每班次（心理负荷中位数为5.5，四分位距为4.0；舒适度中位数为80%，四分位距为20）的认知负荷更高。所有测量维度的复杂度均处于较低水平。心理负荷自17时起呈现升高趋势，而舒适度则自21时起出现下降。 研究结论 自17时起，急诊室住院医师在进行诊疗决策时所承受的心理负荷偏高，且自述舒适度未达最优状态。心理负荷在21时至23时达到峰值。该现象仅在以2小时时段及班次为单位测量认知负荷时得以观察到，而以单次诊疗决策为单位时未发现此规律。本研究可为通过优化急诊室工作重组以降低住院医师认知负荷提供参考依据。