The goal, then, during handoff in the Emergency Department would be to attempt to limit uncertainty and give contingencies. Thirdly, element interactivity, or how information elements interact with each other, influences intrinsic load (4).
Again, this is difficult to control in the Emergency Department, but allowing sufficient time for signout is key. For example, the need for rapid handoff and decision making consumes more working memory. Second, the amount of time available for a task influences intrinsic load (4). In the Emergency Department, the number of patients that we must signout is difficult to control, but we could reduce this cognitive load by discharging individuals prior to signout and listing only the critical comorbidities for each patient. For example, learning about five patients and their comorbidities during sign-out causes a greater load than two. There are four elements that influence intrinsic load:įirst, the number of information elements influences intrinsic load (4). Intrinsic load is the load associated with performing the task, or in this case, the load associated with performing the process of a handoff itself. Managing Intrinsic Load in the Emergency Department Handoff: So What Can We Do to Improve Working Memory and Create Good Handoffs?
These factors can be analyzed by the type of cognitive load that they encompass: intrinsic, extrinsic, germane. There are multiple factors that prevent the sender and receiver from developing the shared mental model, and this concept is explored through cognitive load theory. One proposed framework for handoffs is to create a “shared mental model between the giver and receiver” (4). Working memory is critical to completing a successful handoff, but can easily be overwhelmed.Īppreciating the limits of working memory can help identify the challenges of handoffs. Working memory is limited and can hold no more than five to nine information elements (think of memorizing a phone number, ie. Working memory holds information for a few seconds, with almost all information lost after about 20 seconds, unless the information is rehearsed (1). Working memory is memory for operating a current task (4). Long term memory is a permanent form of memory that utilizes meaningful connections between information elements, and thus can easily be recalled. Sensory memory encompasses brief visual and auditory inputs such as faces/colors/environments, but lasts only 1-2 seconds and generally does not reach consciousness. In cognitive load theory, human memory is divided into three subsystems: Cognitive load theory (CLT) was initially developed in the 1980s from research in cognitive psychology that concluded that there are multiple elements that can overload the learner and reduce problem solving (1,4,7).
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