Cognition and Error Management for Critical Care

描述(由申请人提供)： 医疗差错报告(1999)极大地提高了人们对医疗差错的频度、规模、复杂性和严重性的认识。医疗差错是美国第八大死因，排在机动车事故、乳腺癌和艾滋病之前，需要学术、医疗保健和政府机构立即关注。虽然医疗差错可以从几个角度来处理，如组织重组或自动化，但我们关注的是医疗差错的认知因素及其临床意义。我们提出了一个理论框架，在该框架中，错误被视为不可避免但在认知上有用的现象，不能完全消除。在我们看来，人的错误是人们在适应其复杂的物理、社会和文化环境中的认知活动的产物。我们的认知方法强调在临床问题解决过程中的概念理解和思维过程中的行动。这些行动反映了专业知识的水平和临床表现中的任务需求。为了管理临床决策过程中的错误，关键是要了解决策是如何做出的，以及在与患者、同事和医疗保健环境中的技术交互时，使用什么潜在的认知机制来处理信息。这项拟议研究的广泛目标是建立一个关于重症护理环境(内科、外科和精神病学)中医疗差错的认知框架，在这些环境中，决策通常是在高压力、时间压力和信息不完整的情况下做出的。我们的具体目标包括(1)应用和提炼我们对错误的初始认知分类，其中每一类医疗错误都与特定的认知机制相关联，(2)从理论上解释这些错误发生的原因，并预测这些错误发生的情况。与实现完美性能(通过开发无错误系统)的流行目标不同，这项研究的结果将对开发预测错误、响应错误或替换不太严重的错误的适应性系统产生影响，以便在错误导致不良事件之前进行后续干预。

DESCRIPTION (provided by applicant): The medical error report from the Institute of Medicine (1999) has greatly increased people's awareness of the frequency, magnitude, complexity, and seriousness of medical errors. As the eighth leading cause of death in US, ahead of motor vehicle accidents, breast cancer, and AIDS, medical errors need immediate attention from academic, health care, and government organizations. While medical errors can be dealt with from several perspectives, such as organizational restructuring or automation, our concern is with cognitive factors of medical errors and their clinical implications. We propose a theoretical framework in which errors are viewed as inevitable but cognitively useful phenomena that cannot be totally eliminated. In our view human errors are products of cognitive activities in people's adaptation to their complex physical, social, and cultural environments. Our cognitive approach stresses actions in conceptual understanding and thought processes during clinical problem solving. The actions reflect the level of expertise and the demands of tasks in clinical performance. In order to manage errors during clinical decision-making, it is critical to understand how decisions are made and what underlying cognitive mechanisms are used to process information during interactions with patients, colleagues, and technology in the health care environment. The broad objective of the proposed research is to develop a cognitive framework of medical errors in critical care environments (medicine, surgery and psychiatry), where decisions are often made under high stress, time pressure, and with incomplete information. Our specific aims include (1) applying and refining our initial cognitive taxonomy of errors where each category of medical error is associated with a specific cognitive mechanism, and (2) providing a theoretical explanation of why these errors occur and predicting the circumstances in which such errors would occur. Unlike the popular goal of achieving flawless performance (through development of error-free systems), the results from this study will have implications for developing adaptive systems that anticipate errors, respond to them, or substitute less serious errors that allow subsequent intervention before they result in an adverse event.