IntroductionInterruptions 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.MethodsResident 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.ResultsThirty-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).ConclusionIn 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.

The human cardiovascular system, controlled by the autonomic nervous system (ANS), is one of the first sites where one can see the "fight-or-flight" response due to the presence of external stressors. In this paper, we investigate the possibility of detecting mental stress using a novel measure that can be measured in a contactless manner: Pulse transit time (dPTT), which refers to the time that is required for the blood wave (BW) to cover the distance from the heart to a defined remote location in the body. Loosely related to blood pressure, PTT is a measure of blood velocity, and is also implicated in the "fight-or-flight" response. We define the differential PTT (dPTT) as the difference in PTT between two remote areas of the body, such as the forehead and the palm. Expanding our previous work on remote BW detection from visible spectrum videos, we built a system that remotely measures dPTT. Human subject data were collected under an IRB approved protocol from 15 subjects both under normal and stress states and are used to initially establish the potential use of remote dPPT detection as a stress indicator.

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