Designing Affordance-Based Procedures Using Heuristic Cognitive Work Analysis: Application to Triage in an Emergency Department

Abstract

This study describes the concept of affordance-based procedure and its implementation in a triage station in a hospital emergency department. Rather than seeking to increase operators’ adherence to procedures, an affordance-based procedure (1) aims to induce task steps using affordances that also (2) support degrees of freedom for action. The design of this procedure was guided by the application of an extended version of cognitive work analysis, named “heuristic cognitive work analysis.” This design process produced a new procedural document: a reception card. Ten months after its implementation, a qualitative evaluation with 10 triage nurses shows that the reception card is viewed as supporting coordination between the different nurses’ tasks and providing an external memory to cope with frequent interruptions during high patient inflow, even though the document is used for convenience and with unexpected and partial uses of its items. The document assessed also afforded emerging benefits, that is, acceleration of ambulance release, higher level of confidentiality, assistance for staff hand-overs. Finally, novice triage nurses are particularly sensitive to the benefits brought by this affordance-based procedure.