836: Developing a Cooperative Communication System for Safe, Effective, and Efficient Patient Care.

摘要

Learning Objectives: Developing ecologically valid information technologies (IT) for the intensive care unit (ICU) is challenging. Traditional, quantitative research designs do not sufficiently account for the complexities of individual and team decision making in this work domain. Using a mixed methods Cognitive Systems Engineering (CSE) approach offers a means to go beyond surface descriptions (phenotypes) of the ICU work domain and to reveal underlying patterns (genotypes) of systemic factors that impact decision making. The model of cognitive work it produces supports IT solutions that support clinical work, making decisions more accurate, reliable, and efficient. Methods: A mixed methods CSE approach including observations, interviews, surveys and artifact analysis was conducted over one year during five week-long visits to a 16 bed regional referral Burn ICU in a 450 bed academic military medical center. Results: We discovered 21 barriers to effective patient care including: synchronization of care; awareness of coupled activities; communicating change in patient status across disciplines; availability of current information; delayed, missing, or replaced orders; reliance on verbal orders; coordination between shifts; documentation time; IT process requirements frequently require redundant information capture; data trends not readily available; human data integration; knowledge of resource availability (e.g. who is on the unit); coordination between the BICU and OR; rounds checklist not available to all team members; tracking of dropped tasks; unclear responsibility for task completion; time spent tracking down in-process items like meds and labs; reliance on nurses to track and fix information gaps/resolve conflicts; matching resources to needs; errors (e.g. wrong orders) require unit members to rectify. Conclusions: These barriers affect the cognitive work of Burn ICU clinicians and introduce risk to accurate, reliable, and efficient decision making.