Highly trained clinician cognitive resources are limited. Must be restored after used. Budget these processes for their best use.

Focusing attention

Decision-making (no matter the size of the decision). # of EMR clicks matter as each is a decision. Lack of intuitiveness of design matters.

Sorting

Classifying

Prioritizing

Multi-tasking (shifting back and forth between topics)

Getting back on track after interruption—Best Practice Alerts (BPAs) or other hard stops on EMR matter as they demand attention. Calling attention to something (color, fontsize, etc.) uses less neural resource than demanding attention

Maintenance of goals

Maintenance of information active in working memory. Time/space between finding information and executing action on the information matters.

Updating working memory with new information

Self-regulation, professionalism, self-effacement, despite how treated

Emotion work-dealing with bad outcomes, distressed patients and families

Maintaining “Aequinimitas” in setting of bleeding, injury, pain, etc.

Suppressing previously learned information to lean and operate new device—having differently designed devices which are all used for the same purpose matters.

Lack of cognitive restoration between dognitively draining events. Work outside of work matters. Only tracking units of work without tracking time needed to do the work hampers feedback to organization as two whether adequate resources were provided to do the job needed.

Cognitive workload debt. When mandatory requirements like required extra training for regulatory purposes exist without time provided to accomplish them, this creates more cognitive workload to find the time to reduce the workload debt of the job and reduces the cognitive resource for patient care. IF too much cognitive workload debt accumulates, there is a fracture point past which workload debt cascade occurs, and mental processes degrade in quality [54] .