Advancing patient safety through the use of cognitive aids

Merry, Alan; Mitchell, Simon J

doi:10.1136/bmjqs-2015-004984

Cited by 18 publications

(12 citation statements)

References 13 publications

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“…8 Although this behaviour is poorly understood, one possibility is that cognitive aids are not adequately designed for their intended purpose. 40 Our data provide a potential explanation. Our results should be considered with regard to the specific crisis scenario and task.…”

Section: Discussionmentioning

confidence: 70%

Matching design to use: a task analysis comparison of three cognitive aid designs used during simulated crisis management

Clebone

Burian

Tung

2019

Can J Anesth/J Can Anesth

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Purpose Intraoperative critical events typically include vital sign instability that requires a specific and timesensitive response. Although cognitive aids can improve clinical performance during critical events, their design may not be optimized for real-world use. For example, during a critical event, health practitioners may be familiar with the treatment pathway and only require specific information from an aid-a behaviour described as ''sampling''. We hypothesized that use of cognitive aids designed to facilitate sampling behaviour would reduce the time required to extract information during simulated critical events. Methods We designed two experimental cognitive aids, based on cognitive science research on human performance, to facilitate sampling behaviour. Design principles included content clusters that were specifically located, colour-coded and labelled, the elimination of distractors such as numbering, and a key features

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Section: Discussionmentioning

confidence: 70%

Matching design to use: a task analysis comparison of three cognitive aid designs used during simulated crisis management

Clebone

Burian

Tung

2019

Can J Anesth/J Can Anesth

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“…81 By 2016, Merry noted events leading to harm during anaesthesia often result from omission of key planning steps (such as failure to anticipate and plan for a difficult airway) or other forms of basic oversight. 82…”

Section: Human Factors and Guidelinesmentioning

confidence: 99%

The evolution of airway management – new concepts and conflicts with traditional practice

McNarry

Patel

2017

British Journal of Anaesthesia

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In the last 25 yr, there have been several advances in the safe management of the airway. Videolaryngoscopes and supraglottic airways, now in routine use by new trainees in anaesthesia, have had their genesis in the recent past. The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society published in 2011 a seminal report that has influenced airway management worldwide . Understanding how the report's recommendations were constructed and how clinical guidelines compliment rather than contradict them is important in understanding the tenets of safe airway management. Over the last 25 yr there has been an increasing understanding of the effects of human factors in anaesthesiology: we may not perform in a predictable or optimal manner when faced with unusual and threatening challenges. The place of cricoid pressure in anaesthetic practice has also evolved. Current recommendations are that it be applied, but it should be released rapidly should airway difficulty be encountered. The need to prevent hypoxaemia by preoxygenation has long been recognized, but the role of high-flow nasal oxygen in anaesthesia is now being realized and developed. Clinicians must decide how novel therapies and long-standing practices are adapted to best meet the needs of our patients and prevent harm during airway management.

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“…They may thus already have an initial differential diagnosis, know the appropriate first responses, and only use a cognitive aid to obtain specific information such as drug doses or additional treatment ideas . The usability of this type of aid use—“sampling” only for specific information—may be hampered by a linear, step‐by‐step aid design where the needed information is buried within a list of recommended actions . Data from nonmedical domains support a relationship between design elements of cognitive aids and their perceived usability in both laboratory and real‐world conditions .…”

Section: Introductionmentioning

confidence: 99%

The effect of cognitive aid design on the perceived usability of critical event cognitive aids

Clebone

Burian

Tung

2019

Acta Anaesthesiol Scand

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Background Critical events require that clinicians process information and make decisions quickly. To reduce mental workload during such events, cognitive aids have been developed. We have previously observed that designing such aids to facilitate discrete information transfer decreased time to information finding. However, whether clinicians perceive aids designed for discrete information transfer as more usable than step‐by‐step designs remains unclear. We hypothesized that experimental cognitive aids designed for discrete information transfer would be judged more usable than step‐by‐step Linear aids. Methods Volunteer clinicians were asked to use cognitive aids during low fidelity simulation scenarios. Experimental cognitive aids featuring color‐coded, labeled, and consistently located content clusters were compared with aids formatted in a traditional step‐by‐step fashion. We then performed a quantitative assessment of perceived usability and conducted structured knowledge elicitation interviews. Results Clinicians rated the two experimental cognitive aids as more usable than the Linear aid. On a 0‐100 scale the median (IQR) rating was 25(18,23) for the Linear aid and 89(80,95) and 81(65,90) for the two experimental designs, respectively, with a higher number indicating greater ease of use (P < .01 for each). Narrative responses suggested specific features that improved usability and a thematic analysis identified six major themes driving preference for cognitive aid use. Conclusion During simulated critical events, cognitive aids designed for discrete information transfer were considered more usable than step by step Linear aids. Specific themes governing usability were identified during mixed methods analysis. Further work is needed to optimize cognitive aid use among anesthesia clinicians.

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Advancing patient safety through the use of cognitive aids

Cited by 18 publications

References 13 publications

Matching design to use: a task analysis comparison of three cognitive aid designs used during simulated crisis management

Matching design to use: a task analysis comparison of three cognitive aid designs used during simulated crisis management

The evolution of airway management – new concepts and conflicts with traditional practice

The effect of cognitive aid design on the perceived usability of critical event cognitive aids

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