Tablet-based Cognitive Aids Reduce Errors and Increase Coordination in Crisis Care Teams

Background Doctors are beginning to embrace cognitive aids, such as paper-based checklists or flowcharts, that can ensure higher-quality medical care with lower error rates. However, not much is known about how to effectively design interactive cognitive aids in crisis care situations using modern, mobile technologies. Our goal is to understand how tablet based cognitive aids can be designed to help crisis care anesthesiologists manage the limited resource of their attention. In collaboration with Dr. Larry Chu and Dr. Kyle Harrison in the AIM lab at Stanford’s School of Medicine we have begun to study the use of cognitive aids in heart failure during anesthesia. After understanding the problems in this smaller domain we will generalize to other crisis scenarios. The AIM lab has found that increased use of the paper Cognitive Aids they currently use have been correlated to reduced errors in simulated crisis care scenarios. We hypothesize that adding a display visible to the whole team and embedding cognitive aids within patient vital displays have the potential benefits of assisting teams in managing individual attention, improving team-based communication, and helping teams maintain a shared mental model of the crisis. We will study how the two aspects of the design of interactive cognitive aids affect their usability and effectiveness by varying the size of the cognitive aid displays, their layout within the physical space, and the kind of information they display. Our first prototype will explore how changing the size of the cognitive aid from personal to large monitor changes how the team sees the cognitive aid. We hypothesize that this will reduce errors by helping the team maintain a shared mental model of the important steps in the crisis. Our second prototype will explore how moving the cognitive aid from a separate cart to being embedded within the patient’s vitals display changes the social and attentional aspects of the cognitive aid. We hypothesize this will increase the overall usage of our cognitive aid and that will correlate with reduced errors. Methods We will evaluate two prototypes that build upon the commercially available iPad-based “StanMed” application. Using this application as a prototype, we qualitatively explored the important pieces of a crisis situation and elicited concrete design ideas from doctors. Both of these prototypes will follow this method: Participants are instructed in the use of our cognitive aid prior to a simulation scenario. The researchers watch the scenario from behind a 1-way mirror and video record the training session. We code video of the simulations for interaction errors and make note of of “critical incidents” where tablet-based cognitive aids provide a new opportunity to help doctors, or disrupt work practices. At the end of the scenario we do a post-hoc interview with the participants to gather feedback on the cognitive aid. Both the interviews and the coded video inform the final design of the cognitive aid. We will present the results and conclusions from our design at the Medicine 2.0 conference. Results Research in progress. Conclusions Research in progress []