When Noise Gets into the Notes: Auditory Distraction Effects on Triage Documentation in a Simulated ED Waiting Room

Abstract

Emergency department (ED) waiting rooms have complex soundscapes where nurses sometimes perform triage and documentation amid task-irrelevant sounds. This study examined whether auditory distraction affects documentation accuracy across noise types and interval patterns. Thirty-two ED nurses completed simulated triage in the Tesseract, an immersive multimodal simulation environment, across four Noise Types (alarms, infant crying, conversations, quiet baseline) and two Noise Intervals (continuous or intermittent). A behaviorally anchored error-coding framework with strong interrater reliability was used to assess severity-weighted documentation errors and free-text entry error counts. Noise conditions produced no significant effects on cumulative severity-weighted errors over quiet baseline. Free-text entry errors showed a significant Noise Type × Noise Interval interaction effect, χ 2 (2) = 12.92, p = .002. Conversations produced the highest error counts under continuous and infant crying under intermittent noise interval. Findings suggest noise-related errors can be dependent on the momentary soundscape, and documentation processes are vulnerable to disruption.