Cognitive overload, medical errors and clinical communication strategy

Chief Nursing Officer Rhonda Collins examines strategies to simplify communication and offload clinicians’ burden of retrieving, retaining and recording information.

Each year, in Australia, medical errors result in as many as 18,000 unnecessary deaths, and more than 50,000 people become disabled each year.¹ Communication problems and cognitive overload have been associated with medical errors, which hospitals can address with a communication strategy that helps reduce the cognitive load of healthcare workers.

What is the connection between cognitive overload and medical errors?

Hospital-based health workers are constantly segmenting 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. You are also constantly splitting your attention among multiple sources. This can lead to cognitive overload and may leave you unable to focus on a critical patient care task.

How do you explain cognitive load in the clinical environment?

A clinician responsible for several patients encounters a constant influx of information that must be cognitively processed — an ongoing act of sense-making and learning. Learning theory identifies three types of cognitive load:

1. Intrinsic cognitive load is the cognitive effort expended to complete a problem or task. For clinicians, intrinsic load is affected by stress factors that diminish working memory and can be compounded by larger, deeper emotions such as shame, guilt or grief.
2. Extrinsic cognitive load is the cognitive effort the environment demands. If you’re bombarded with information and you can’t control how it’s coming at you, you can have a heavy extrinsic load.
3. Germane cognitive load is the effort expended to make sense of new information. If you receive a lab value with no context and have to retrieve past values and other information to understand the complete picture, your germane cognitive load is heavy.

What problems need solving to help reduce cognitive load and overload?

Clinicians often have to solve complex problems without full context, or have to split attention between multiple sources of information and pay attention to too many things concurrently. Clinicians also struggle to communicate with each other, hindered by barriers such as multiple standards, conflicting protocols and disparate communication tools. This is a drain on working memory.

The pervasive need for redundant documentation is another problem. When you have to write the same information three or four times in three or four different places — while also juggling information for four to six different patients — you’re likely to make a mistake.

Nuisance notifications pose another challenge — perhaps a nurse doesn’t need to receive a patient’s vital signs every ten minutes if a patient is stable.

How can hospitals solve these challenges?

A hospital using a single clinical communication and collaboration (CC&C) platform can 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, such as Vocera^®, can make all the difference.

For more information, visit https://www.vocera.com/au/cno-perspective-2020.

Discover how you can develop communication strategies to help reduce cognitive overload — visit the Vocera Cognitive Overload hub.

Reference

1. Saul N Weingart, Ross McL Wilson, Robert W Gibberd, Bernadette Harrison. Epidemiology of medical error. BMJ; 320: 774–7.

Rhonda Collins, DNP, DN is Chief Nursing Officer at Vocera Communications Inc.

Image credit: ©stock.adobe.com/au/pathdoc