Revealing ICU Cognitive Work Through Naturalistic Decision-Making Methods

Abstract

The fragile health of patients who are admitted to a burn intensive care unit (ICU) requires clinicians and clinical teams to perform complex cognitive work that includes time-pressured diagnostic and therapeutic decisions that are based on emergent and interrelated patient information. Barriers to clinician efforts delay patient care and increase care cost, length of stay, and the potential for misadventures. The Cooperative Communication System is a real-time information technology system in its final year of development that is designed to support individual and team cognitive work and communication in the burn ICU. The project has used cognitive systems engineering methods to reveal genotypes: the traits that mold this naturalistic decision-making work setting. Requirements derived from findings guided development of seven core features, configurable displays, and machine learning features that enable clinicians to obtain and use the most important information on individual patients and among and across patients. Recent evaluation data demonstrate the system’s usability and value to the clinical staff. More efficient, reliable collaboration among members of the ICU staff who use the Cooperative Communication System is expected to improve patient safety and improve patient outcomes.