Distraction-Related Phenomena in Emergency Department Work: A Systematic Literature Review from a Cognitive Ergonomics Perspective

Background: Emergency departments are cognitively demanding environments where healthcare professionals are frequently exposed to interruptions and other distracting factors that may compromise workflow and patient safety. This systematic review aimed to identify factors that distract healthcare professionals in emergency departments and to synthesise their cognitive, organisational, and patient-safety consequences from a cognitive ergonomics perspective. Methods: A systematic literature review was conducted in PubMed, CINAHL Ultimate, Web of Science, and ScienceDirect in accordance with the PRISMA 2020 statement. Studies meeting predefined eligibility criteria were included. Methodological quality was assessed using design-specific critical appraisal tools, and findings were synthesised using inductive content analysis. Results: Nineteen studies met the predefined eligibility criteria and were included in the synthesis. The most frequently reported distraction-related phenomena included communication-related interruptions, telephone calls, and technological and environmental disturbances, while multitasking and task switching were identified as related work processes or responses to competing demands. Across the studies, distraction-related phenomena were associated with cognitive and workflow consequences, including increased workload, reduced situation awareness, work-related stress, and workflow disruption. Only one of the 19 included studies directly examined task errors, whereas the others identified interruptions during medication-related activities and potential safety concerns without directly measuring medication errors or patient harm. Several studies also identified clinically relevant interruptions associated with information exchange and care coordination, alongside unnecessary or poorly timed interruptions that were perceived as disruptive. Conclusions: Distraction-related phenomena are common features of emergency department work and are associated with cognitive and workflow outcomes. However, direct evidence regarding clinical errors and patient safety outcomes remains limited, and the available findings do not establish a causal relationship between distraction-related phenomena and patient harm. Potential cognitive-ergonomic strategies may focus on reducing avoidable and low-value interruptions while preserving clinically necessary communication that supports information exchange and care coordination; however, their effectiveness requires empirical evaluation.