2080447788430860 Macquarie University, Sydney, Australia.
5333 University of the Sunshine Coast, Queensland, Australia.
Hum Factors. 2022 Feb;64(1):74-98. doi: 10.1177/0018720821995668. Epub 2021 Mar 9.
Emergency departments (EDs) are complex socio-technical work systems that require staff to manage patients in an environment of fluctuating resources and demands. To better understand the purpose, and pressures and constraints for designing new ED facilities, we developed an abstraction hierarchy model as part of a work domain analysis (WDA) from the cognitive work analysis (CWA) framework. The abstraction hierarchy provides a model of the structure of the ED, encompassing the core objects, processes, and functions relating to key values and the ED's overall purpose.
Reviews of relevant national and state policy, guidelines, and protocol documents applicable to care delivery in the ED were used to construct a WDA. The model was validated through focus groups with ED clinicians and subsequently validated using a series of WDA prompts.
The model shows that the ED system exhibits extremely interconnected and complex features. Heavily connected functions introduce vulnerability into the system with function performance determined by resource availability and prioritization, leading to a trade-off between time and safety priorities.
While system processes (e.g., triage, fast-track) support care delivery in ED, this delivery manifests in complex ways due to the personal and disease characteristics of patients and the dynamic state of the ED system. The model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety.
The model identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.
急诊科（ED）是复杂的社会技术工作系统，要求工作人员在资源和需求不断变化的环境中管理患者。为了更好地理解设计新的急诊科设施的目的、压力和限制，我们从认知工作分析（CWA）框架中开发了一个抽象层次模型作为工作域分析（WDA）的一部分。该抽象层次模型提供了急诊科结构的模型，包括与关键价值观和急诊科整体目的相关的核心对象、过程和功能。
对适用于急诊科护理的相关国家和州政策、指南和协议文件进行审查，用于构建 WDA。通过与急诊科临床医生进行焦点小组讨论对模型进行验证，然后使用一系列 WDA 提示对其进行验证。
该模型表明，ED 系统表现出极其互联和复杂的特征。功能之间的紧密连接会给系统带来脆弱性，功能性能取决于资源的可用性和优先级，从而导致时间和安全优先级之间的权衡。
虽然系统流程（例如分诊、快速通道）支持急诊科的护理提供，但由于患者的个人和疾病特征以及 ED 系统的动态状态，这种提供方式表现出复杂的方式。该模型确定了系统约束，这些约束在护理提供过程中造成紧张（例如，电子数据输入、计算机可用性），可能会危及患者安全。
该模型确定了急诊科系统的各个方面，可以通过创新的急诊科系统设计来提高急诊科的性能。
