Simulation and Education Training Center, Banner Good Samaritan Medical Center, Phoenix, AZ 85016, USA.
J Biomed Inform. 2011 Jun;44(3):425-31. doi: 10.1016/j.jbi.2011.04.003. Epub 2011 Apr 13.
Protocol standardizations are important for consistent and safe practices. However, complex clinical environments are highly dynamic in nature and often require clinicians, confronted with non-standard situations, to adjust and deviate from standard protocol. Some of these deviations are errors which can result in harmful outcomes. On the other hand, some of the deviations can be innovations, which are dynamic adjustments to the protocols made by people to adapt the current operational conditions and achieve high accuracy and efficiency. However, there is very little known about the underlying cognitive processes that are related to errors and innovations. In this study we investigate the extent to which deviations are classified as errors or innovations, as a function of expertise in a trauma setting. Field observations were conducted in a Level 1 trauma unit. A total of 10 trauma cases were observed and collected data was analyzed using measures that included customized activity-error-innovation ontology, timestamps and expertise of the team members. The results show that expertise of the caregivers and criticality of a patient's condition in critical care environment influence the number and type of deviations from standard protocol. Experts' deviations were a combination of errors and innovations; whereas the novices' deviations were mostly errors. This research suggests that a novel approach must be taken into consideration for the design of protocols (including standards) and compliance measurements in complex clinical environments.
方案标准化对于确保一致性和安全性至关重要。然而，复杂的临床环境本质上是高度动态的，往往要求临床医生在面对非标准情况时进行调整并偏离标准方案。其中一些偏差是错误，可能导致不良后果。另一方面，一些偏差可以是创新，这是人们对方案进行的动态调整，以适应当前的操作条件，并实现高精度和高效率。然而，人们对与错误和创新相关的潜在认知过程知之甚少。在这项研究中，我们调查了在创伤环境中，专业知识对偏差分类为错误或创新的程度。现场观察在一级创伤单位进行。共观察了 10 个创伤病例，并使用包括定制活动-错误-创新本体、团队成员的时间戳和专业知识在内的措施来分析收集的数据。结果表明，护理人员的专业知识和危重病患者在重症监护环境中的病情严重程度会影响偏离标准方案的次数和类型。专家的偏差是错误和创新的结合；而新手的偏差大多是错误。这项研究表明，在复杂的临床环境中，必须考虑采用新方法来设计方案（包括标准）和衡量合规性。
