How Cognitive Artifacts Support Distributed Cognition in Acute Care

Abstract

In acute health care, tightly constrained teams of service providers perform complex procedures that routinely have significant consequences. Recent patient safety research encourages the use of decision support tools to improve human performance. Multiple hospital departments collaborate in a distributed cognition to balance the demand for health care with resources such as care providers, equipment and facilities. To plan and manage the balance, an anesthesiologist and a nurse coordinator predict resource availability, build consensus among team members, resolve disputes, plan resource allocation, assess and re-plan the balance between need and resources, speculate about future needs, create trial solutions, anticipate resource requirements, bump procedures and stash and husband resources. The Availabilities Sheet, Master Schedule, Operating Room (OR) Graph and OR Board are four cognitive artifacts used to support their work. Artifacts must, at a minimum, be reliable, informative, efficient, clear, accurate, and malleable. Improvements to these and other information tools will benefit team work processes and thereby enhance patient safety. An example demonstrates how cognitive artifacts are used to support distributed cognition.