A 5-Point Communication Strategy to Help Reduce Clinicians’ Cognitive Load

Medical errors are the third leading cause of death behind heart disease and cancer in the U.S., and more than a quarter of a million occur each year. Communication problems are the most common root cause of medical errors, and clinician cognitive overload has also been correlated with them.

Cognitive overload, information processing, and medical errors

To understand the connection between cognitive overload and medical errors, let’s look at how the clinical environment affects clinicians’ ability to process information.

Humans parse and make sense of what is going on around us through the act of segmenting. As a clinician in a hospital environment, you constantly segment what is important and urgent. When you receive too many pieces of information at once, you become overloaded and have difficulty segmenting. This can lead to mistakes. When you must constantly split your attention among multiple sources and pay attention to too many things simultaneously, you can become overloaded and unable to focus on critical patient care tasks.

Cognitive load in the clinical environment

One of our core skills of cognition is being able to categorize information and put it in the proper place. We do this in working memory, which is limited in both capacity and duration. When we receive new information, it sits in short-term memory for about 20 seconds by some estimates. After that, we lose the information.

A clinician dealing with four to six patients simultaneously encounters a constant influx of information. The cognitive processing of it is an ongoing act of sensemaking and of learning, and is affected by factors such as:

• The level of cognitive effort you need to expend to complete a problem or task.
• The level of cognitive effort demanded of you by the working environment.
• The level of cognitive effort you must expend to make sense of new information.

Key problems hospitals need to solve for to help reduce clinicians’ cognitive load and overload

Clinical leaders can help reduce clinicians’ cognitive load by addressing five key areas.

• Lack of context: Clinicians often have to solve complex problems without full context. You might have a piece of standalone information, such as a lab value, but you can’t slot that information into any file system in your head that makes sense to you.
• Split attention: Clinicians often have to split attention between multiple sources of information and pay attention to too many things concurrently.
• Difficulty communicating: Clinicians often struggle to fundamentally communicate with each other. They are hindered by barriers such as multiple standards, conflicting protocols, and disparate communication software. The difficulty of communicating is a drain on working memory.
• Pervasive need for redundant documentation: When you have to write the same information in three or four different places while you’re busy and juggling information about four to six different patients, you’re likely to make a mistake.
• Nuisance notifications: 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 that a patient’s SpO2 has dropped down to 88% when that patient normally sats at 88%.

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. Working memory is limited in capacity and duration. 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.

Here are some capabilities to look for in a platform to help reduce clinicians’ cognitive load:

1. Contextualize information: Choose a platform that enables clinicians to receive communication that includes patient identifiers as well as relevant context.
2. Deflect distractions to focus on critical tasks: Be sure the platform allows a mobile device to be set to Do Not Disturb mode (which can be overridden for truly urgent matters) so messages are sent into voicemail when a clinician needs to focus. The clinician can listen to messages when his or her brain has working capacity available.
3. Provide a single source of information and standard protocols: To make it easier for clinicians to communicate with each other, choose a platform that lets you create a standard protocol for communication so 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: Choose technology that lets you offload the need to retrieve, retain, and record certain types of information so you don’t need to carry it in your working memory, providing a single source of information where information is accessible to the entire care team and doesn’t need to be replicated again and again.
5. Weed out extraneous information: Help reduce interruption fatigue from nuisance notifications by choosing a platform that lets you filter them out so clinicians receive only the information they need to deal with.

In the process of selecting technology clinicians will use, include a clinical expert at the table for every discussion. Always lead with the patient, and make sure technology enables the care team to interact with the patient and focus on the patient at the center to streamline workflow.

Rhonda Collins, DNP, RN is the Chief Nursing Officer at Vocera. You can follow her on Twitter at @RhondaCNO.