Perceived cognitive load among emergency department code blue teams: distribution, correlates and relationship with team performance.

Abstract

Advanced life support algorithms standardise core actions during cardiac arrest, yet clinical resuscitation also requires coordination, adaptation and decision-making under time pressure. This study examined perceived cognitive load across team roles and its association with team performance in authentic clinical emergency department teams. In this multicentre cross-sectional study with prospective data collection, perceived cognitive load was measured using the Paas 9-point mental effort scale. Team performance was assessed using the Team Emergency Assessment Measure (TEAM), completed by participating team members and aggregated at event level. A total of 58 resuscitations with 228 healthcare professional observations were included. Perceived cognitive load varied across roles and was highest among team leaders (mean 5.5, SD 1.7). In multilevel analysis, the team leader role was associated with higher perceived cognitive load (β = 1.12, 95% CI 0.27-1.98, p = 0.025), whereas increasing age and more than ten years of clinical experience were associated with lower load. Team leaders' perceived cognitive load was positively associated with cognitive load among team members (β = 0.53, 95% CI 0.38-0.67, p < 0.001) and negatively associated with TEAM-assessed team performance (β = -0.80, 95% CI -1.38 to -0.23, p = 0.007). Perceived cognitive load was unevenly distributed within resuscitation teams, with highest levels among team leaders. Higher team leader cognitive load was associated with higher load among other team members and lower TEAM-assessed performance, highlighting team leader cognitive load as a relevant target for future research and interventions to support resuscitation team performance.