Capabilities | Decision Support & Human Factors

Decision Support & Human Factors

ARA studies individual and group cognitive work in high-hazard domains to produce valid, reliable descriptions that provide decision and design requirements with solutions from information displays and systems to new work processes and facilities.

ARA researchers develop research methods that include Cognitive Task Analysis (CTA) to uncover key aspects of cognitive performance among:

  • blood bank technicians
  • cardiac care nurses
  • emergency department teams
  • health care consumers
  • health care facility surveyors
  • ICU nurses
  • ICU teams
  • neonatal nurses
  • oncologists

ARA health and safety projects include:

  • adverse event forensic investigation
  • cognitive aid development for ICU clinicians
  • medical device evaluation
  • patient safety studies
  • surgeon fatigue studies
  • surgical suite visual display development
  • NICU Expertise (National Institute of Health)

    Experienced NICU nurses often detect changes in the health status of their patients before family members or physicians. CTA was used to understand how they were able to do so and that understanding was used to train less experienced nurses.

    • Applying the Critical Decision Method, ARA identifies key components of experienced nurses' clinical assessment skills
    • Through the Critical Decision Method, we learn that nurses rely on perception-recognition skills to assess critically-ill patients
    • The method identifies a common set of previously undocumented cues that can now be made available to less experienced nurses
  • Decision Support & Human Factors

    ARA uses a variety of methods to understand medical errors in order to identify opportunities for error reduction

    • Acute care misadventures are often not fully understood
    • Methods to better understand errors include interviews, cognitive walk-through exercises, simulations, event reconstruction and cognitive artifact analysis
    • Identify a series of causes that contribute to errors including staff overloading, inconsistent communication and information gaps
  • NICU Expertise (National Institute of Health)
    • Provide design directions for a large screen display to support cognitive work and reduce safety challenges of cardiac surgery teams
    • Apply decision-centered design and cognitive task analysis interviews
    • Offer a preliminary concept for wall of knowledge
  • Patient Safety in the OR
    Patient in OR prior to surgery

    • Develop a tailored intervention to improve communication and teamwork within surgical teams, reduce errors and enhance patient safety
    • In-depth interviews/observations revealed challenges related to information quality and timeliness
    • ARA facilitated a co-creative process with members of the general surgery team to create a pre-operative briefing to support team communication and problem detection
  • Emergency Medicine Expertise
    Intensive Care Unit

    • Collect data at two world-renowned ICUs in the US
    • Identify specific cognitive task failures compromising the practice of critical care medicine
    • Provide recommendations on supporting and training for the cognitive activities through use of both low- and high-tech decision aids
  • Emergency Medicine Expertise
    • In-depth cognitive task analysis interviews with experienced physicians and emergency medicine interns
    • Identify characteristics that define EM expertise and areas where interns were most challenged
    • Develop recommendations for addressing organizational barriers to skill development, accelerating the learning of inexperienced EM physicians
  • Emergency Medicine Expertise
    • Reduce medical errors by improving communication and coordination among medical staff
    • Apply observations and cognitive task analysis at an emergency department
    • Create an electronic decision making exercise to improve decision making and coordination by addressing issues with roles, functions, expectations and shared vision
  • Patient Data Management
    Example Patient Data Display: Merge AIMS™

    • Develop design concepts for patient data displays
    • Use cognitive task analysis to identify the knowledge, goals, strategies and decisions used when reviewing and retrieving patient data
    • Use decision-centered design to develop concepts supporting decisions made by staff before and during patient visits
  • Alternative Therapies
    Alternative therapies used for cancer treatment (

    • Study how practicing oncologists evaluate the appropriateness of alternative therapies for cancer treatment
    • Explore the conditions under which alternative therapies enter into their practices and interview oncologists regarding their decision-making model
    • Compare "traditional" oncologists with those who offer alternative therapies
  • Develop a dosimetry model to study the health impact of exposure to fibers in humans, rats and mice for the Environmental Protection Agency Develop a dosimetry model to study the health impact of exposure to fibers in humans, rats and mice for the Environmental Protection Agency
    Emergency departments include a number of high- and low-tech systems for patient care

    • Develop a set of design metrics for evaluating the impact of newly developed systems on users' cognitive work
    • Evaluate the extent to which a system supports user cognitive work
    • Make recommendations to modify and improve a system
  • 3-D imaging & Computer Modeling of the Respiratory Tract (NIH)
    Blood banking is critical for patient care, but there is a lack of standardization in training and tasks

    • Apply cognitive task analysis to elicit expert knowledge and reveal problem areas in antibody identification
    • Findings include heuristics, errors, competency shortfalls and barriers
    • Identify training and evaluation problems, recommend standardized responsibilities across technologies and greater capacity among supervisors for defining /assessing skills
  • Health Care Facility Surveyor Expertise (Centers for Medicaid and Medicare Services)
    • Problem with novice surveyors not detecting violations of regulations or injury to patients in long-term care facilities
    • Cognitive task analysis interviews used to elicit cognitive challenges
    • Recommend training solutions to improve surveyors' abilities to manage the critical cognitive demands of their job
  • The Power of Intuition in Clinical Practice
    Clarian Health’s Safe Passage Program seeks to assure that a patient has a safe hospital stay

    • Conduct a series of workshops for safe passage nursing staff with the goal of improving patient safety across multiple hospitals
    • Teach recognizing and articulating intuition
    • Develop and used decision-making exercises to train new nurses in the use of intuitive techniques
  • Assessment strategies of cytotechnologists
    Cytotechnology is the microscopic study of cells for evidence of disease

    • Apply cognitive task analysis with experienced cytotechnologists
    • Findings include detailed descriptions of the assessment processes and diagnostic strategies employed
    • Findings used to test and refine technologies for automated pathology slide scanning
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