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West J Emerg Med. 2019 Jan;20(1):177-184. doi: 10.5811/westjem.2018.10.39962. Epub 2018 Nov 30.

Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation.

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University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts.
Clinical and Translational Science Institute, Tufts Medical Center and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center Boston, Massachusetts.
University of Massachusetts Medical School-Baystate, Academic Affairs, Springfield Massachusetts.



Interruptions 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.


Resident 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.


Thirty-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).


In 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.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Numbers UL1TR000073 and UL1TR001064. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr. William Soares is supported by a NIH 1K08DA045933–01 grant.

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