title: Quantifying the impact of cross coverage on physician's workload and performance in radiation oncology.
abstract: OBJECTIVE
  To quantitatively assess the difference in workload and performance of radiation oncology physicians during radiation therapy treatment planning tasks under the conditions of "cross coverage" versus planning a patient with whom they were familiar.
  
  
  METHODS
  Eight physicians (3 experienced faculty physicians and 5 physician residents) performed 2 cases. The first case represented a "cross-coverage" scenario where the physicians had no prior information about the case to be planned. The second exposure represented a "regular-coverage" scenario where the physicians were familiar with the patient case to be planned. Each case involved 3 tasks to be completed systematically. Workload was assessed both subjectively (perceived) using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), and objectively (physiological) throughout the task using eye data (via monitoring pupil size and blink rate). Performance of each task and the case was measured using completion time. Subjective willingness to approve or disapprove the generated plan was obtained after completion of the case only.
  
  
  RESULTS
  Forty-eight perceived and 48 physiological workload assessments were obtained. Overall, results revealed a significant increase in perceived workload (high NASA-TLX score) and decrease in performance (longer completion time and reduced approval rate) during cross coverage. There were nonsignificant increases in pupil diameter and decreases in the blink rate during cross-coverage versus regular-coverage scenario. In both cross-coverage and regular-coverage scenarios the level of experience did not affect workload and performance.
  
  
  CONCLUSIONS
  The cross-coverage scenario significantly increases perceived workload and degrades performance versus regular coverage. Hence, to improve patient safety, efforts must be made to develop policies, standard operating procedures, and usability improvements to electronic medical record and treatment planning systems for "easier" information processing to deal with cross coverage, while recognizing strengths and limitations of human performance.
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina. Electronic address: prithima_mosaly@med.unc.edu.
authors.forename: Prithima R
authors.initials: PR
authors.lastname: Mosaly
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lukasz M
authors.initials: LM
authors.lastname: Mazur
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lesley
authors.initials: L
authors.lastname: Hoyle
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Timothy
authors.initials: T
authors.lastname: Zagar
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Bhishamjit S
authors.initials: BS
authors.lastname: Chera
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks