SHM Converge Scientific Abstract ePoster Gallery-Rapid Quality Improvement of a Multidisciplinary Nocturnal Hospitalist Team to Optimize Clinician Attention and Cognitive Load

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This project describes a rapid quality improvement initiative to improve the “ecology of attention” in a multidisciplinary nocturnist hospitalist team. The authors argue that hospitalist work requires sustained “deep work” — focused, cognitively demanding effort — but that this is often disrupted by pages, electronic messages, role ambiguity, workflow unpredictability, and environmental noise. These distractions increase cognitive load and may reduce quality, satisfaction, and safety.<br /><br />The team first used focus groups and surveys to identify key sources of distraction during nocturnal shifts. Early findings highlighted three major problems: excessive low-priority paging and instant messaging without good triage by urgency; unclear provider roles during education, handoffs, and emergencies; and unpredictable workflow patterns. Based on these findings, the group proposed an initial improvement cycle including role redesign, such as creating a dedicated triagist, standardizing instant-message management, and building “focus breaks” into workflow using message forwarding.<br /><br />The project also presents a broader framework for improving attention in healthcare. Suggested strategies include prioritizing communication quality over frequency, designing physical spaces that support concentration, evaluating the effect of staffing and role structures on task switching, optimizing the electronic health record to reduce burden, developing measurement tools for attention-related outcomes, and embedding attention as an organizational value.<br /><br />To evaluate interventions, the team plans to use a combination of Plan-Do-Study-Act cycles, NASA Task Load Index scores, qualitative feedback, EMR data, and operational metrics such as patient volume, length of stay, throughput, and patient outcomes.<br /><br />Overall, the project aims to reduce distraction and cognitive burden for nocturnist hospitalists and improve clinician focus, efficiency, and care quality.

Asset Subtitle

Samuel C. Porter

Meta Tag

Author List Angela Keniston, Colleen Long, Jennifer M. Post, Katherine C. Jankousky, Katherine J. Kissler, Marisha Burden, Mark J. Kissler, Samuel C. Porter

Category Innovations

Concept Deep Work

Concept Focused Attention

Concept Hospitalist Clinical Work

Concept Distraction

Concept Cognitive Load

Distinguished Non-Finalist

Presenter Organization University of Colorado

Presenting Author Samuel C. Porter

Track Quality Improvement

Keywords

hospitalist

nocturnist

deep work

cognitive load

attention management

workflow disruption

paging triage

role ambiguity

electronic health record

quality improvement

Deep Work

Focused Attention

Hospitalist Clinical Work

Distraction

Cognitive Load