{"pk":12088,"title":"Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation","subtitle":null,"abstract":"Introduction:\n Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that emergency physicians (EP) frequently encounter. To address interruptions such as ECG interpretation, many EPs engage in task switching, pausing their primary task to address an interrupting task. The impact of task switching on clinical errors in interpreting screening ECGs for STEMI remains unknown.\nMethods:\n Resident and attending EPs were invited to participate in a crossover simulation trial. Physicians first completed a task-switching simulation in which they viewed patient presentations interrupted by clinical tasks, including screening ECGs requiring immediate interpretation before resuming the patient presentation. Participants then completed an uninterrupted simulation in which patient presentations and clinical tasks were completed sequentially without interruption. The primary outcome was accuracy of ECG interpretation for STEMI during task switching and uninterrupted simulations.\nResults:\n Thirty-five participants completed the study. We found no significant difference in accuracy of ECG interpretation for STEMI (task switching 0.89, uninterrupted 0.91, paired t-test p=0.21). Attending physician status (odds ratio [OR] [2.56], confidence interval [CI] [1.66-3.94], p<0.01) and inferior STEMI (OR [0.08], CI [0.04-0.14], p<0.01) were associated with increased and decreased odds of correct interpretation, respectively. Low self-reported confidence in interpretation was associated with decreased odds of correct interpretation in the task-switching simulation, but not in the uninterrupted simulation (interaction p=0.02).\nConclusion:\n In our simulation, task switching was not associated with overall accuracy of ECG interpretation for STEMI. However, odds of correct interpretation decreased with inferior STEMI ECGs and when participants self-reported low confidence when interrupted. Our study highlights opportunities to improve through focused ECG training, as well as self-identification of “high-risk” screening ECGs prone to error during interrupted clinical workflow.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"task switching"},{"word":"electrocardiogram"},{"word":"Interruptions"},{"word":"emergency physician"}],"section":"Original Research","is_remote":true,"remote_url":"https://escholarship.org/uc/item/88j2786m","frozenauthors":[{"first_name":"William","middle_name":"E.","last_name":"Soares III","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts","department":"None"},{"first_name":"Lori","middle_name":"L.","last_name":"Price","name_suffix":"","institution":"Clinical and Translational Science Institute, Tufts Medical Center and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center Boston, Massachusetts","department":"None"},{"first_name":"Brendan","middle_name":"","last_name":"Prast","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts","department":"None"},{"first_name":"Elizabeth","middle_name":"","last_name":"Tarbox","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts","department":"None"},{"first_name":"Timothy","middle_name":"J.","last_name":"Mader","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts","department":"None"},{"first_name":"Rebecca","middle_name":"","last_name":"Blanchard","name_suffix":"","institution":"University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts","department":"None"}],"date_submitted":"2018-07-22T09:25:54Z","date_accepted":"2018-07-22T09:25:54Z","date_published":"2018-11-30T20:48:16Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12088/galley/6478/download/"}]}