Observational study of clinician attentional reserves (OSCAR): Acuity-based rounds help preserve clinicians’ attention

OBJECTIVES: Team rounding in the ICU can tax clinicians’ finite attentional resources. We hypothesized that a novel approach to rounding, where patients are seen in a decreasing order of acuity, would decrease attentional attrition.

DESIGN: Prospective interventional internal-control cohort study in which stop signal task testing was used as a proxy for attentional reserves. Stop signal task is a measure of cognitive control and response inhibition in addition to performance monitoring, all reflective of executive control abilities, and our surrogate for attentional reserves.

SETTING: The ICUs of Vanderbilt University Medical Center (site 1) and the University of Pennsylvania (site 2) from November 2014 to August 2017.

SUBJECTS: Thirty-three clinicians at site 1, and 24 clinicians at site 2.

INTERVENTIONS: Acuity-based rounding, in which clinicians round from highest to lowest acuity as determined by Sequential Organ Failure Assessment score or an equivalent acuity score.

MEASUREMENTS AND MAIN RESULTS: The stop signal task results of ICU staff at two sites were compared for conventional (in room order) versus novel (in decreasing order of acuity) rounding order. At site 1, the difference in stop signal reaction time change between two rounding types was -39.0 ms (95% CI, -50.6 to -27.4 ms; p < 0.001), and at site 2, the performance stop signal reaction time was -15.6 ms (95% CI, -29.1 to -2.1 ms; p = 0.023). These sub-second changes, while small, are significant in the neuroscience domain.

CCONCLUSIONS: Rounding in decreasing order of patient acuity mitigated attrition in attentional reserves when compared with the traditional rounding method.