Clinical Implications of Cognitive Complexity in Critical Care

  • Khalid F. Almoosa
  • R. Stanley Hum
  • Timothy G. Buchman
  • Bela Patel
  • Vafa Ghaemmaghami
  • Trevor Cohen
Chapter
Part of the Health Informatics book series (HI)

Abstract

The evolution of critical care medicine and the Intensive Care Unit (ICU) has been a major advance in the success of modern medicine. Critical care medicine is a subspecialty that provides intensive life-sustaining monitoring and therapies for patients with life-threatening conditions in a very specialized setting. Each year, more than five million patients are admitted to the 5,000 ICUs in the United States [1], and the cost to sustain this care exceeds $90 billion annually [2]. Critical care is very dynamic, fast-paced, and complex in content and delivery, and optimal critical care is provided round-the-clock by a highly specialized, multi-disciplinary team. The provision of critical care has improved outcomes such as mortality and has prolonged and saved countless lives since its inception.

Keywords

Intensive Care Unit Critical Care Error Detection Error Management Critical Care Physician 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Angus DC, Kelley MA, Schmitz RJ, White A, Popovich Jr J. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762–70. PubMed PMID: 11105183. Epub 2000/12/06. eng.PubMedCrossRefGoogle Scholar
  2. 2.
    Pronovost PJ, Needham DM, Waters H, Birkmeyer CM, Calinawan JR, Birkmeyer JD, et al. Intensive care unit physician staffing: financial modeling of the Leapfrog standard. Crit Care Med. 2006;34(3 Suppl):S18–24. PubMed PMID: 16477199. Epub 2006/02/16. eng.PubMedCrossRefGoogle Scholar
  3. 3.
    I.O.M. To err is human. Institute of Medicine Washington, DC: National Academy Press; 1999.Google Scholar
  4. 4.
    Payne VP, Vimla L. Heuristics and biases in critical care decision-making. In: Patel VL, Kaufman DR, Cohen T, editors. Cognitive informatics: case studies on critical care, complexity, and errors. London: Springer; 2013.Google Scholar
  5. 5.
    Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775–80. PubMed PMID: 12915363. Epub 2003/08/14. eng.PubMedCrossRefGoogle Scholar
  6. 6.
    Leape LL, Berwick DM. Five years after to err is human: what have we learned? JAMA. 2005;293(19):2384–90. PubMed PMID: 15900009. Epub 2005/05/19. eng.PubMedCrossRefGoogle Scholar
  7. 7.
    Hutchins EB. How a cockpit remembers its speeds. Cogn Sci. 1995;19:265–88.CrossRefGoogle Scholar
  8. 8.
    Rasmussen JG. The role of error in organizing behavior. Ergonomics. 1990;33:1185–99.CrossRefGoogle Scholar
  9. 9.
    Patel VL, Groen CJ, Patel YC. Cognitive aspects of clinical performance during patient workup: the role of medical expertise. Adv Health Sci Educ Theory Pract. 1997;2(2):95–114. PubMed PMID: 12386402. Epub 1997/01/01. Eng.PubMedCrossRefGoogle Scholar
  10. 10.
    Patel VL, Groen GJ, Arocha JF. Medical expertise as a function of task difficulty. Mem Cognit. 1990;18(4):394–406. PubMed PMID: 2381318.Epub 1990/07/01. eng.PubMedCrossRefGoogle Scholar
  11. 11.
    Patel VL, Cohen T. New perspectives on error in critical care. Curr Opin Crit Care. 2008;14(4):456–9. PubMed PMID: 18614912. Epub 2008/07/11. eng.PubMedCrossRefGoogle Scholar
  12. 12.
    Cohen TP, Patel VL. A framework for understanding error and complexity. In: Patel VK, Kaufman DR, Cohen T, editors. Cognitive informatics: case studies on critical care, complexity, and errors. London: Springer; 2013.Google Scholar
  13. 13.
    Patel VL, Cohen T, Murarka T, Olsen J, Kagita S, Myneni S, et al. Recovery at the edge of error: debunking the myth of the infallible expert. J Biomed Inform. 2011;44(3):413–24. PubMed PMID: 20869466. Epub 2010/09/28. eng.PubMedCrossRefGoogle Scholar
  14. 14.
    Razzouk E, Cohen T, Almoosa K, Patel V. Approaching the limits of knowledge: the influence of priming on error detection in simulated clinical rounds. AMIA Annu Symp Proc. 2011;2011:1155–64. PubMed PMID: 22195176. Pubmed Central PMCID: 3243217. Epub 2011/12/24. eng.PubMedGoogle Scholar
  15. 15.
    Kubose T, Patel V, Jordan J. Dynamic adaptation to critical care medical environment: error recovery as cognitive activity. In: Annual meeting of the cognitive science society, 2002;8–10.Google Scholar
  16. 16.
    Amalberti R, Wioland, L. In: Soekka H, editor. Human error in aviation safety: human factors, system engineering, flight operations, economics, strategies, management. Brill Academic Publishers; The Netherlands 1997.Google Scholar
  17. 17.
    Schmitt MH, Gilbert JH, Brandt BF, Weinstein RS. The coming of age for interprofessional education and practice. Am J Med. 2013;126(4):284–8. PubMed PMID: 23415053. Epub 2013/02/19. eng.PubMedCrossRefGoogle Scholar
  18. 18.
    Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY. Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. 2009;53(6):701–10.e4. PubMed PMID: 18555560. Epub 2008/06/17. eng.PubMedCrossRefGoogle Scholar
  19. 19.
    Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94. PubMed PMID: 14744724. Epub 2004/01/28. eng.PubMedCrossRefGoogle Scholar
  20. 20.
    Riesenberg LA, Leitzsch J, Massucci JL, Jaeger J, Rosenfeld JC, Patow C, et al. Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med. 2009;84(12):1775–87. PubMed PMID: 19940588. Epub 2009/11/27. eng.PubMedCrossRefGoogle Scholar
  21. 21.
    Arora VM, Johnson JK, Meltzer DO, Humphrey HJ. A theoretical framework and competency-based approach to improving handoffs. Qual Saf Health Care. 2008;17(1):11–4. PubMed PMID: 18245213. Epub 2008/02/05. eng.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Eaton EG, Horvath KD, Lober WB, Pellegrini CA. Organizing the transfer of patient care information: the development of a computerized resident sign-out system. Surgery. 2004;136(1):5–13. PubMed PMID: 15232532. Epub 2004/07/03. eng.PubMedCrossRefGoogle Scholar
  23. 23.
    Arora V, Johnson J. A model for building a standardized hand-off protocol. Jt Comm J Qual Patient Saf. 2006;32(11):646–55. PubMed PMID: 17120925. Epub 2006/11/24. eng.PubMedGoogle Scholar
  24. 24.
    Stein DM, Vawdrey DK, Stetson PD, Bakken S. An analysis of team checklists in physician signout notes. AMIA Annu Symp Proc. 2010;2010:767–71. PubMed PMID: 21347082. Pubmed Central PMCID: 3041400. Epub 2011/02/25. eng.PubMedGoogle Scholar
  25. 25.
    Mistry KP, Jaggers J, Lodge AJ, Alton M, Mericle JM, Frush KS, et al. Performance and tools. In: Henriksen K, Batties JB, Keyes MA, Grad ML. Rockville Maryland, editors. Tools and Practices Using six sigma(R) methodology to improve handoff communication in high-risk patients performance and tools. 2008. PubMed PMID: 21249919. Epub 2011/01/21. eng.Google Scholar
  26. 26.
    Harvey CM, Schuster RJ, Durso FT, Matthews AL, Surabattula D. Human factors of transition of care. In: Carayon P, editor. Handbook of human factors and ergonomics in healthcare and patient safety. Mahwah: Lawrence Erlbaum Associates; 2007.Google Scholar
  27. 27.
    Riesenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. Am J Med Qual. 2009;24(3):196–204. PubMed PMID: 19269930. Epub 2009/03/10. eng.PubMedCrossRefGoogle Scholar
  28. 28.
    Collins SA, Mamykina L, Jordan D, Stein DM, Shine A, Reyfman P, et al. In search of common ground in handoff documentation in an intensive care unit. J Biomed Inform. 2012;45(2):307–15. PubMed PMID: 22142947. Pubmed Central PMCID: 3306473. Epub 2011/12/07. eng.PubMedCrossRefGoogle Scholar
  29. 29.
    Abraham J, Kannampallil TG, Patel VL. Bridging gaps in handoffs: a continuity of care based approach. J Biomed Inform. 2012;45(2):240–54. PubMed PMID: 22094355. Epub 2011/11/19. eng.PubMedCrossRefGoogle Scholar
  30. 30.
    Abraham JA, Almoosa K. Falling through the cracks: investigation of care continuity in critical care handoffs. In: Patel VL, Kaufman DR, Cohen T, editors. Cognitive informatics: case studies on critical care, complexity, and errors. London: Springer; 2013.Google Scholar
  31. 31.
    Streitenberger K, Breen-Reid K, Harris C. Handoffs in care–can we make them safer? Pediatr Clin North Am. 2006;53(6):1185–95. PubMed PMID: 17126690. Epub 2006/11/28. eng.PubMedCrossRefGoogle Scholar
  32. 32.
    Berkenstadt H, Haviv Y, Tuval A, Shemesh Y, Megrill A, Perry A, et al. Improving handoff communications in critical care: utilizing simulation-based training toward process improvement in managing patient risk. Chest. 2008;134(1):158–62. PubMed PMID: 18628218. Epub 2008/07/17. eng.PubMedCrossRefGoogle Scholar
  33. 33.
    Vankipuram M, Kahol K, Cohen T, Patel VL. Toward automated workflow analysis and visualization in clinical environments. J Biomed Inform. 2011;44(3):432–40. PubMed PMID: 20685315. Epub 2010/08/06. eng.PubMedCrossRefGoogle Scholar
  34. 34.
    Chen CI, Liu CY, Li YC, Chao CC, Liu CT, Chen CF, et al. Pervasive observation medicine: the application of RFID to improve patient safety in observation unit of hospital emergency department. Stud Health Technol Inform. 2005;116:311–5. PubMed PMID: 16160277. Epub 2005/09/15. eng.PubMedGoogle Scholar
  35. 35.
    Mamykina LH, Hum S, Kaufman D. Investigating shared mental models in critical care. In: Patel VK, Kaufman DR, Cohen T, editors. Cognitive informatics: case studies on critical care, complexity, and errors. London: Springer; 2013.Google Scholar
  36. 36.
    Kannampallil T, Li Z, Zhang M, Cohen T, Robinson DJ, Franklin A, et al. Making sense: sensor-based investigation of clinician activities in complex critical care environments. J Biomed Inform. 2011;44(3):441–54. PubMed PMID: 21345380. Epub 2011/02/25. eng.PubMedCrossRefGoogle Scholar
  37. 37.
    Vankipuram M, Kahol K, Cohen T, Patel VL. Visualization and analysis of activities in critical care environments. AMIA Annu Symp Proc. 2009;2009:662–6. PubMed PMID: 20351937. Pubmed Central PMCID: 2815477. Epub 2009/01/01. eng.PubMedGoogle Scholar
  38. 38.
    Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32. PubMed PMID: 17192537. Epub 2006/12/29. eng.PubMedCrossRefGoogle Scholar
  39. 39.
    Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306. PubMed PMID: 23269131. Epub 2012/12/28. eng.PubMedCrossRefGoogle Scholar
  40. 40.
    Wood KA, Angus DC. Reducing variation and standardizing practice in the intensive care unit. Curr Opin Crit Care. 2001;7(4):281–3. PubMed PMID: 11571427. Epub 2001/09/26. eng.PubMedCrossRefGoogle Scholar
  41. 41.
    Holcomb BW, Wheeler AP, Ely EW. New ways to reduce unnecessary variation and improve outcomes in the intensive care unit. Curr Opin Crit Care. 2001;7(4):304–11. PubMed PMID: 11571430. Epub 2001/09/26. eng.PubMedCrossRefGoogle Scholar
  42. 42.
    Rozich JD, Howard RJ, Justeson JM, Macken PD, Lindsay ME, Resar RK. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004;30(1):5–14. PubMed PMID: 14738031. Epub 2004/01/24. eng.PubMedGoogle Scholar
  43. 43.
    Myneni SC, Cohen T, Almoosa KF, Patel VL. Standard solutions for complex settings: the idiosyncrasies of a weaning protocol use in practice. In: Patel VK, Kaufman DR, Cohen T, editors. Cognitive informatics: case studies on critical care, complexity, and errors. London: Springer; 2013.Google Scholar
  44. 44.
    Kahol K, Vankipuram M, Patel VL, Smith ML. Deviations from protocol in a complex trauma environment: errors or innovations? J Biomed Inform. 2011;44(3):425–31. PubMed PMID: 21496496. Epub 2011/04/19. eng.PubMedCrossRefGoogle Scholar
  45. 45.
    ACS. Advanced trauma life support for doctors. Chicago: American College of Surgeons (ACS) Committee on Trauma; 2004.Google Scholar
  46. 46.
    Vankipuram MG, Ghaemmaghami V, Patel VL. Adaptive behaviors in complex clinical environments. In: Patel VK, Kaufman DR, Cohen T, editors. Cognitive informatics: case studies in critical care, complexity, and errors. London: Springer; 2013.Google Scholar
  47. 47.
    van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67. PubMed PMID: 11794168. Epub 2002/01/17. eng.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Khalid F. Almoosa
    • 1
  • R. Stanley Hum
    • 2
  • Timothy G. Buchman
    • 3
  • Bela Patel
    • 4
  • Vafa Ghaemmaghami
    • 5
    • 6
  • Trevor Cohen
    • 7
  1. 1.Division of Critical Care Medicine, Memorial Hermann HospitalUniversity of Texas Health Science Center, Texas Medical CenterHoustonUSA
  2. 2.Department of Pediatrics, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Emory Center for Critical CareEmory University School of Medicine, Woodruff Health Sciences Center, Emory UniversityAtlantaUSA
  4. 4.Critical Care Medicine, Memorial Hermann HospitalUniversity of Texas Health Science Center, Texas Medical CenterHoustonUSA
  5. 5.Trauma Division, Department of SurgeryBanner Good Samaritan HospitalPhoenixUSA
  6. 6.University of Arizona College of MedicinePhoenixUSA
  7. 7.School of Biomedical InformaticsUniversity of Texas Health Science CenterHoustonUSA

Personalised recommendations