Nigel Kim

Program: Biomedical Informatics and Data Science

Current advisor: Thomas G. Kannampallil, PhD

Undergraduate university: Washington University, 2019

Enrollment year: 2021

Research summary
Using electronic health record (EHR) audit logs data, we found that EHR work is highly fragmented in the ICU, and higher rate of attention switching was associated with increased time in the EHR and increased risk for wrong-patient errors.

Clinical work environments, especially intensive care settings, are characterised by multiple competing demands, requiring clinicians to switch their attention between over- lapping tasks. Previous time-and-motion studies have suggested that ICU clinicians perform ~150 tasks per hour.1 Given the limitations of human cognition, attention switching has been shown to be associated with decreased productivity and performance, increased cognitive burden, and errors in non-clinical settings.2 However, the consequences of attention switching are less understood in clinical settings due to reliance on labour-intensive observational studies to measure attention switching. In this study, we developed a scalable metric for attention switching based on passively collected electronic health record (EHR) audit log data,3 and used it to assess the downstream effects of attention switching in ICU clinicians. We hypothesised that a higher rate of attention switching is associated with more time spent using the EHR and more wrong-patient errors.
In summary, we found that EHR work was highly frag- mented, with frequent attention switching between different patients. For APPs, who are front-line clinicians directly responsible for patient care, a high rate of attention switching was associated with downstream effects such as an increase
in total EHR time, which has wellness implications given prior literature relating EHR use to burnout.7 More strikingly, attention switching was also associated with an increased risk for wrong-patient errors, consistent with prior literature on the effects of task-related interruptions.

Graduate publications
Lou SS, Kim S, Harford D, Warner BC, Payne PRO, Abraham J, Kannampallil T. 2022 Effect of clinician attention switching on workload and wrong-patient errors. Br J Anaesth, 129(1)::e22-e24.