The Functional Necessity of Interruption in Rapidly Changing, Unpredictable, and Demanding Task Environments
With Ben Swets (Grand Valley State University) and Peter Viccellio (SBUH Department of Emergency Medicine).
The Emergency Room and similar environments are characterized by distribution of tasks and information across team members, probabilistic problem solutions, limited and variable access to resources, fluctuating priorities, and uncertainty in the nature, number, and timeline of tasks. The frequent interruptions observed in such settings have been traditionally viewed as harmful to performance. We conceptualize interruptions instead as providing critical and well-timed reminders to complete an unfinished task or to inform the doctor of ongoing shifts in case status. We have found that relevant interruptions can be quite valuable in the context of an ER environment and other high-demand situations. This project was funded through the James S. Todd Memorial Research Grant from the National Patient Safety Foundation. For further information about the project and its findings, click here.
Cognitive Processes Underlying Medical Diagnostic Errors
With Mark Graber (Chief of Medicine, Northport VA Medical Center) and Ruthanna Gordon (EPA Innovation Team). We jointly reviewed a large number of quality assurance reports of medical errors, and we developed a taxonomy of general cognitive factors that appear to underly a wide range of diagnostic error. This represents a first step toward determining appropriate interventions and medical tools aimed at reducing the second most common class of costly medical mistakes. This project was funded through a research grant by the National Patient Safety Foundation.
Relevant Papers
Graber, M., Franklin, N., & Gordon, R. (2002). Reducing diagnostic errors in medicine: What's the goal? Academic Medicine, 77, 981-992.
Gordon, R. & Franklin, N. (2003). Cognitive underpinnings to Diagnostic Error: Reply to Croskerry. Academic Medicine, 78, 782.
Graber, M., Franklin, N., & Gordon, R. (2004). Diagnostic error in internal medicine. Archives of Internal Medicine, 165, 1493-1499.