Malhotra Sameer, Jordan Desmond, Shortliffe Edward, Patel Vimla L
Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA.
J Biomed Inform. 2007 Apr;40(2):81-92. doi: 10.1016/j.jbi.2006.06.002. Epub 2006 Jun 9.
The intensive care unit (ICU) is an instance of a very dynamic health care setting where critically ill patients are being managed. To provide good care, an extensive and coordinated communication amongst the role players, use of numerous information systems and operation of devices for monitoring and treatment purposes are required. The purpose of this research is to study error evolution and management within this environment. The focus is on representing the workflow of critical care environment, which emphasizes the importance such a representation may play in strategizing the management of medical errors. We used ethnographic observation and interview data to build individual pieces of the workflow, dependent on the individual and the activity concerned. Key personnel were intensively followed during their respective patient care activities and the related actions. All interactions were recorded for analysis. These clinicians and nurses were interviewed to complement the observation data and to delineate their individual workflows. These pieces of the ICU workflow were used to develop a generalize-able cognitive model to represent the intricate workflow applicable to other health care settings. The proposed model can be used to identify and characterize medical errors and for error prediction in practice.
重症监护病房（ICU）是一个极具动态性的医疗环境，用于管理重症患者。为了提供优质护理，需要各参与方进行广泛且协调的沟通，使用众多信息系统以及操作用于监测和治疗目的的设备。本研究的目的是研究该环境中的差错演变与管理。重点在于呈现重症监护环境的工作流程，这强调了这种呈现方式在制定医疗差错管理策略中可能发挥的重要作用。我们利用人种学观察和访谈数据来构建工作流程的各个部分，具体取决于所涉及的个人和活动。在关键人员各自的患者护理活动及相关行动期间，对他们进行密切跟踪。记录所有互动以便进行分析。对这些临床医生和护士进行访谈，以补充观察数据并描绘他们各自的工作流程片段。这些ICU工作流程片段被用于开发一个通用的认知模型，以呈现适用于其他医疗环境的复杂工作流程。所提出的模型可用于识别和描述医疗差错，并在实践中进行差错预测。
