Problem Density, Mental Workload and Medical Error in Primary Care Practice

Key DFM Personnel

Jon Temte MD, PhD - Principal Investigator
Paul Smith, MD - WREN Director
Ben-Tzion Karsh, PhD - Co Investigator
Michael Grasmick, PhD - Researcher

Funding

Agency for Health Care Research and Quality

Summary

Provision of healthcare services to patients in primary care practices is chaotic and complex. Medical errors can thrive in an environment of inattention, competing demands and time stress. Is there a linkage between problem density, resulting clinician mental workload and quality of care and medical error?

Methods

Observational study of 30 physicians each reporting data from 20 routine adult patient visits over a four-week period (n= 600 visits). The unit of analysis is the clinical encounter. Specific data will include patient age and gender, the patient's anticipated number of medical issues to be discussed during the visit, clinician mental workload as measured by the post-visit NASA TLX, physician reported number and types of problems addressed, face-to-face time spent during the visit, physician estimated likelihood of error, patient reported extent to which concerns were addressed, and a copy of the resulting clinical note for assessment of quality indicators around blood pressure and tobacco use. Correlations between encounter problem density, clinician mental workload, and perceived medical error will be evaluated. Structured interviews will be conducted with physicians on a subset (n~30) of outlying encounters (i.e., high problem density and low mental workload).

Significance

Improved insight into the clinical encounter for clinicians, and identification of correlates and possible reduction of medical errors and omissions.