Helping experts and expert teams perform under duress: an agenda for cognitive aid research

Who should read cognitive aid prompts?

“…We note that Everett's group did not coach participants as to who should read the cognitive aids, and as such they found a degree of confusion. Before we introduced our own prompt cards, we were concerned that there are recognised hurdles to checklist and cognitive aid use [2]. Furthermore, Burden's group found that clinicians demonstrated difficulty reading a cognitive aid whilst simultaneously gathering clinical information and communicating to the team [3].…”

Cognitive aids and ‘behavioural anaesthesia’

“…The danger of having no theoretical basis for research into human behaviour is frustration and failure to progress. [1]. We were interested to read that they were unable to demonstrate any benefit, as this reflects findings from our recent study.…”

“…Recent decades have seen a rapid growth in research to improve patient safety, well illustrated by two articles and an accompanying editorial in the March edition of Anaesthesia [1][2][3]. Everett et al and Harvey et al describe the performance of cognitive aids in different contexts, and the editorial discusses their findings.…”

“…The studies follow similar patterns, the measurement of 'impact' of cognitive aids on particular practices [2,3]. The editorial by Marshall discusses what should be the optimal design and format of cognitive aids, where they should be kept and how they should be used, and cites many studies of what worked and what did not work previously [1]. The articles and editorial are illuminating, but do not acknowledge any underpinning theory, model or conceptual proposition.…”

“…The complexity of the latter requires a different research approach. Marshall assumes that human behaviour is replicable within narrow parameters, when concluding that simulation is best placed to teach and test the use of cognitive aids because one can control experimental parameters [1]. Unfortunately, this is not the case, and similar experimentation is doomed to unsatisfactory stagnation.…”