How Cognitive Artifact Support of Acute Care Distributed Cognition Affects Patient Safety

Demands for acute care are uncertain and change frequently, while resources to meet them are constrained and subject to production pressure. To manage this conflict, the anesthesiology coordinator makes continual assessments and tradeoffs between and among patients and work groups. The complexity and uncertainty of the acute environment requires the creation and use of common artifacts such as display boards, lists, and worksheets that are part of the distributed cognition. We describe a project in which ethnographic methods reveal the strategies, shown in schemata analyses, that anesthesia coordinators use to develop schedules. Such research promises to benefit the evolution of medical informatics, which is the software and computing systems that support the organization, management and use of health care information. Experience shows that digital replicas of physical cognitive artifacts are often blind to the needs of those who are expected to use them. The resulting effects of this clumsy automation can impede staff performance rather than improve it. The research approach described here will assist in understanding the traits of acute care technical work and successful physical artifacts, which promises to improve medical informatics. Better digital cognitive artifacts will benefit work processes, including planning, communications and resource management and thereby benefit patient safety.