911: Card Sorts Help "Unpack" Clinician Perspectives on Patient Condition and Treatment Priorities.

摘要

Learning Objectives: Patient care in the burn intensive care unit (BICU) is complex and understanding clinician decision making is a challenging. We developed a card sort to learn how clinicians perceive patient condition and how they prioritize care. Results will support development of cognitive aids to improve communication and decision making. Methods: We developed the card sort through serial interviews with experts in burn critical care. The interviews discovered 10 categories of information that clinicians use to assess patient condition ( features ) and 9 categories of care elements ( treatment ) they use to manage patient care. This resulted in 97 total cards (67 features and 30 treatments). During the card sorts, clinicians were asked to identify a patient s severity of illness on a scale from could die today to could leave the ICU today. Clinicians then reviewed cards. They chose the cards they considered important to how they identified the patient s condition and what treatments should be given. The resulting arrangement of cards depicts a visual representation of the mental model they use to understand and care for patients. Results: The research team completed 133 card sorts were performed on clinicians from three backgrounds (nurse, physician, other) caring for 70 patients. Clinician experience ranged from 0 42 years. Card sorts took on average 32 minutes to complete. Of the cards that were chosen, clinicians identified identical feature cards 48 23% of the time, and treatment cards 55 25% of the time. While most clinicians identified severity of illness similarly, there were notable differences with perceptions related to 7 patients (> 3 point variance). Clear patterns of clinician perspective emerged that can be used to develop cognitive aids. Conclusions: Card sorting is a simple, effective method to help clinicians unpack their complex, intuitive understanding of patients and how they prioritize information and treatment.