Characterizing the Nature of Work and Forces for Decision Making in Emergency Care
Healthcare as a complex system [1] is exemplified in emergency medicine [2, 3]. Emergency Departments (EDs) are dynamic, adaptive, and self-organizing. Additionally, ED providers are faced with inherent unpredictability regarding the number and severity o
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Characterizing the Nature of Work and Forces for Decision Making in Emergency Care Amy Franklin, David J. Robinson, and Jiajie Zhang
Introduction Healthcare as a complex system [1] is exemplified in emergency medicine [2, 3]. Emergency Departments (EDs) are dynamic, adaptive, and self-organizing. Additionally, ED providers are faced with inherent unpredictability regarding the number and severity of patients, concurrent management of multiple individuals requiring timely responses, and a need to cope with limited resources all within a life-critical, interruption-laden environment [4]. The layered complexity of such units includes the functions of the work, the implementation of technology, the people, the activities and workflows jointly performed by the people and the technology, as well as the social, physical, cultural, and organizational environment in which the ED is embedded. Managing the cognitive, physical, spatial, and temporal resources in such systems is crucial for patient safety and quality of care. Understanding the interaction of the complexity of this work and the environment, particularly as it relates to decision-making, is a first step in engineering solutions to support physician efforts.
Section 3 is adapted from Franklin et al’s (2011) paper Opportunistic decision making and complexity in emergency care, Journal of Biomedical Informatics. 44, 469–476. A. Franklin, PhD (*) • J. Zhang, PhD, MS, FACMI School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX 77030, USA National Center for Cognitive Informatics and Decision Making in Healthcare (NCCD), Houston, TX 77030, USA e-mail: [email protected] D.J. Robinson, MD, MS, FACEP Department of Emergency Medicine, University of Texas Medical Center, Houston, TX 77030, USA V.L. Patel et al. (eds.), Cognitive Informatics in Health and Biomedicine, Health Informatics, DOI 10.1007/978-1-4471-5490-7_7, © Springer-Verlag London 2014
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The purpose of this chapter is to consider the complexity of emergency care at two levels: (1) methods for describing the functions of the emergency care work domain and the associated complexity and (2) the impact of specific workflows and environments on those functions. The ultimate goal of our efforts is to create health information technology to support the Emergency Department. We begin by creating a Work Domain Ontology or description of work. Then narrowing the focus of ED efforts to task transitions, we next describe decision-making patterns as physicians shift between activities finding use of local rules to govern action. Looking at specific implementations of different workflows and different physical layouts, we detail the impact of these factors on decision making. Finally, we conclude with future directions for Health Information Technology (HIT) interventions in complex healthcare scenarios.
Understanding Complexity Using a Work Domain Ontology (WDO) In order to better reveal Emergency Department complexity, we need an abstract descriptio
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