Typing speed and accuracy as the measures of emergency medicine resident physician neurocognitive function impacted by fatigue

Abstract

Introduction: Fatigue impairs work performance, communication, and escalates the risk of poor clinical outcomes and workplace injuries. This study evaluated the utility of measuring typing speed and transcription accuracy to assess the neurocognitive impact of fatigue secondary to shift work and time of day on emergency medicine resident (EMR) physicians. Materials and Methods: This prospective, observational, Institutional Review Board approved, single institution exploratory study assessed a cohort of EMR physicians' typing speed and transcription accuracy at three separate times of day: 0900-day shift, 1600-evening shift, and 0400-overnight shift. Physicians were allotted 2 min to type different patient care scenarios based on investigator availability, which were assessed for character count and transcription errors. Results: Investigators screened 35 subjects twice during day, evening, and overnight shifts. Subjects typed significantly higher mean character counts during day (126.0 + 23.5) and evening shifts 140.1 + 24.1 compared to overnight (114.2 + 23.3; P < 0.001). Postgraduate year (PGY) group mean character count interaction trended toward significance based on time of day: PGY1 121.4, 133.1, 109; PGY2 131.5, 140.6, 119.9; PGY3 125.5; 146.7, 114.3; P = 0.07. Median transcription errors for the cohort did not demonstrate statistical significance based on time of day: day 6 (0-28), evening 5 (0-24), and overnight 5 (0-21), p. 09. PGY status did not significantly impact median transcription errors based on time of day: PGY1 3.5, 4.0, 5.0; PGY2 6, 4, 4; PGY3 7, 7, 7; P = 0.17. Conclusion: Assessing typing speed and accuracy provides meaningful information regarding the impact of fatigue on physician neurocognitive status. The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning and improvement, and Systems-based practice.