Attention performance in emergency physicians: the effect of shift duration and cardiac arrest cases

OBJECTIVE: Emergency departments (EDs) are high-acuity clinical environments characterized by a high demand for sustained attention and significant cognitive load. This study aimed to evaluate the impact of shift timing and high-stress clinical events, such as cardiac arrest, on the attentional performance of emergency medicine specialists. METHODS: This prospective observational study was conducted in the emergency department of a tertiary care hospital, enrolling 23 emergency medicine specialists. Participants’ attentional performance was measured using the mobile Stroop Color-Word Test. Assessments were performed at two-hour intervals during 8-hour shifts and also pre- and post-cardiac arrest events. The collected data were analyzed in relation to variables including shift type, number of cardiac arrests, and resuscitation success. RESULTS: Stroop scores differed significantly by shift type (p = 0.021, η² ≈ 0.07), with the highest attentional performance observed during the evening shift and the lowest during the night shift. A significant decline in attentional performance was noted following cardiac arrest events (median difference: −3 points, p < 0.001; r = 0.59), a pattern that was consistent across all shift types. Furthermore, post-resuscitation attentional levels were significantly higher after successful outcomes (Return of Spontaneous Circulation, ROSC) compared to unsuccessful ones (p = 0.017; r ≈ 0.30). Mixed-effects multivariate analysis revealed that working the night shift (β = −3.1), an increased number of cardiac arrests (β = −0.8 per event), and an unsuccessful ROSC outcome (β = −2.4) were all independently associated with lower attentional performance. CONCLUSION: This study demonstrates that night shifts, frequent exposure to cardiac arrests, and unsuccessful resuscitation outcomes adversely affect the attentional performance of emergency physicians. These findings suggest that physicians are more cognitively vulnerable in the ED, particularly during night hours and following high-stress clinical situations. These results underscore the need for a re-evaluation of shift scheduling and the development of structural interventions to support physicians after critical incidents, with the ultimate goal of enhancing clinical safety.