Research
Critical care physician cognitive task analysis: an exploratory study
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* Corresponding author: James C Fackler fackler@jhmi.edu
1 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
2 Division of Pulmonary and Critical Care, Northwestern University School of Medicine, 251 East Huron, Chicago, IL 60611, USA
3 Klein Associates, Applied Research Associates, 1750 Commerce Center Blvd, Fairborn, OH 45324, USA
Critical Care 2009, 13:R33 doi:10.1186/cc7740
See related commentary by Sevdalis and Brett, http://ccforum.com/content/13/2/139
Published: 5 March 2009Abstract
Introduction
For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, the workflow of every physician team in every academic medical centre has been irrevocably altered. We explored the use of cognitive task analysis (CTA) techniques, most commonly used in other high-stress and time-sensitive environments, to analyse key cognitive activities in critical care medicine. The study objective was to assess the usefulness of CTA as an analytical tool in order that physician cognitive tasks may be understood and redistributed within the work-hour limited medical decision-making teams.
Methods
After approval from each Institutional Review Board, two intensive care units (ICUs) within major university teaching hospitals served as data collection sites for CTA observations and interviews of critical care providers.
Results
Five broad categories of cognitive activities were identified: pattern recognition; uncertainty management; strategic vs. tactical thinking; team coordination and maintenance of common ground; and creation and transfer of meaning through stories.
Conclusions
CTA within the framework of Naturalistic Decision Making is a useful tool to understand the critical care process of decision-making and communication. The separation of strategic and tactical thinking has implications for workflow redesign. Given the global push for work-hour limitations, such workflow redesign is occurring. Further work with CTA techniques will provide important insights toward rational, rather than random, workflow changes.