Identifying performance options and constraints on everyday clinical practice: Applying Cognitive Work Analysis to Emergency Department care
TimeTuesday, April 134:10pm - 4:30pm EDT
LocationPatient Safety Research and Initiatives
DescriptionSummary: The current study used the Work Domain Analysis, Control Task Analysis, and Social Organisational Cooperation Analysis phases of the Cognitive Work Analysis framework to provide clinicians and managers in our study Emergency Departments (ED) with a better understanding of how their current ED functioned in order to optimise design and implementation of care in a new facility.
Application: The models identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.
Background: ED 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 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. To better understand the constraints that shape patient flow and everyday work in the ED, we applied the Control Task Analysis (i.e., Contextual Activities Template, CAT) and Social Organisational Cooperation Analysis (SOCA) phases from the Cognitive Work Analysis framework to identify ways in which to optimise patient flow.
Key points: 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 WDA model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety. The CAT and SOCA-CAT models highlight areas within the department that are heavily loaded with tasks and human and technical agents performing these tasks, while other areas are underutilised. The findings suggest that investment in hospital infrastructure such as effective, functional information technology could directly reduce the time patients spend in ED, improve health outcomes and indirectly reduce the cost of health care.