Using Cognitive Task Analysis in a Medical Setting
Cognitive task analysis; decision making; neonatal intensive care; respiratory distress syndrome; expert systems
New medical systems often fail to gain acceptance by by staff because they do not integrate with local work practices. An expert system, FLORENCE (Fuzzy LOgic REspiratory Neonatal Care Expert), is being developed to help clinical staff in a neonatal intensive care unit (NICU) make decisions about ventilator settings when treating babies with Respiratory Distress Syndrome. For FLORENCE to succeed it must be dependable—that includes being both clinically useful and acceptable to staff—in the context of local work practices. The aim of this work was to identify those contextual factors that would affect FLORENCE’s success.
Work context analysis is not normally mentioned in texts on CTA. On the basis of its usefulness here, in identifying the underlying work structures in the practice of neonatal care and generating implications for the acceptability of FLORENCE, it should be considered more often when carrying out a CTA. In particular it has helped to identify the areas where FLORENCE can provide support for current practice (such as prompting staff to follow the DOPE mnemonic to check the ventilator equipment), where it could change existing practice (such as the need for the data records produced by FLORENCE to be incorporated into the patient records, and highlighting possible data redundancy issues), and more traditional ergonomic issues (such as the need for space to accommodate FLORENCE, and the need for clear, legible displays that can be unambiguously read when staff are standing at the ventilator).
The implications for FLORENCE are manifold. FLORENCE must
not undermine the existing hierarchical communication channels in the
NICU (A). The re-design of working practices to incorporate FLORENCE,
reinforced through its user interface, must ensure that expert help
is called on as appropriate (A). The procedures adopted with FLORENCE
should ensure the validity of the data on which the advice is based
(C). For example, FLORENCE could prompt staff to manually check the
data before implementing any suggested changes. FLORENCE’s audible
alarm should be clearly distinguishable from existing NICU alarms (D);
new procedures should be established to ensure that FLORENCE alarms
receive appropriate attention (D), and FLORENCE should minimise the
generation of unnecessary false alarms (B, D). FLORENCE should always
provide the data and reasoning to support its suggestions (A, C, D).
The CTA identified several contextual issues that could affect FLORENCE’s
acceptance. These issues, which extend beyond FLORENCE’s capability
to suggest changes to the ventilator settings, are being addressed in
the design of the user interface and plans for FLORENCE’s subsequent
|Page Maintainer: email@example.com||Credits||Project Members only||Last Modified: 4 October, 2006|