Dynamic Adaptation to Critical Care Medical Environment: Error Recovery as Cognitive Activity

Early research on errors focused on studies of human reliability in engineering domains. Human components were considered as additional elements in the system, similar to other technical components. Just as technical safety is improved through the reduction of technical breakdowns, it seemed common sense to use a symmetrical rationale to improve safety through the reduction of human errors. In the last few years, Patel and colleagues have reported a number of studies that focused on understanding dynamic decision making in high velocity medical environments, namely intensive care and medical emergency units (Patel and Arocha, 2000; Patel, Kaufman, and Magder, 1996). These and other studies have identified the problems of post-hoc analysis in research on error detection and faults in such environments, that are characterized by high levels of urgency, uncertainty, and shifting, ill-defined, and competing goals. Although such investigations into human error sometimes necessitate a post-hoc analysis, and can be very informative in identification and reduction of future errors, such retrospective analysis presents several problems.