Situation awareness amongst emergency care practitioners

The increase and changes in the demand for emergency care require pro-active responses from the designers and implementers of the emergency care system. The role of Emergency Care Practitioner (ECP) was introduced in England to improve the delivery of emergency care in the community. The role was evaluated using cost-benefit approach and compared with other existing emergency care roles. An analysis of the cognitive elements (situation awareness (SA) and naturalistic decision making (NDM)) of the ECP job was proposed considering the mental efforts involved. While the cost-benefit approach can justify further spending on developing the role, a cognitive approach can provide the evidence in ensuring the role is developed to fulfil its purpose. A series of studies were carried out to describe SA and NDM amongst ECPs in an ambulance service in England. A study examined decision-making process using Critical Decision Method interviews which revealed the main processes in making decision and how information was used to develop SA. Based on the findings, the subsequent studies focus on the non-clinical factors that influence SA and decision making. Data from a scoping study were used to develop a socio-technical systems framework based on existing models and frameworks. The framework was then used to guide further exploration of SA and NDM. Emergency calls that were assigned to ECPs over a period of 8 months were analysed. The analysis revealed system-related influences on the deployment of ECPs. Interviews with the ECPs enabled the identification of influences on their decision-making with respect to patient care. Goal-directed task analysis was used to identify the decision points and information requirements of the ECPs. The findings and the framework were then evaluated via a set of studies based on an ethnographic approach. Participant observations with 13 ECPs were carried out. Field notes provided further insight into the characteristics of jobs assigned to the ECPs. It was possible to map the actual information used by the ECP to their information needs. The sources of the information were classified according to system levels. A questionnaire based on factors influencing decision-making was tested with actual cases. It was found that the items in the questionnaire could reliably measure factors that influence decision-making. Overall, the studies identify factors that have direct and indirect influences on the ECP job. A coherent model for the whole emergency care systems can be developed to build safety into the care delivery process. Further development of the ECP role need to consider the support for cognitive tasks in light of the findings reported in this thesis

A Method for Representing Contextualized Information (MeRCI) to Improve Situational Awareness Among Electronic Message Brokering System Dashboard Users

Electronic health information brokering systems are of interest to public health informatics because they emphasize how data can be effectively shared and utilized across healthcare institutions and among providers so as to improve the quality of care, increase efficiency, and reduce costs (Lumpkin, 2002). In the domain of public health (PH) specifically, where complete and timely reporting of data is critical for all epidemiological and disease surveillance activities (Langmuir, 1976), it is imperative to ensure proper functioning of the electronic information exchange infrastructure. Receiving multiple types of data, in various formats from numerous sources, and triaging them to the appropriate surveillance system is no easy task for a department of health, whether at state, local or federal level (Magnuson, 2005). The administrators of the electronic message brokering system, and the coordinators of surveillance systems in each public health jurisdiction, are responsible for ensuring that the data is received, archived, validated and triaged appropriately in a timely and complete fashion. This requires continuous monitoring of trends in messaging and system performance and active responses to aberrations. To achieve this, administrators depend heavily on dashboards to provide awareness of exchange system status and its reporting at any point of time. Unfortunately, current dashboards do not offer the context or cognitive support needed for interpreting the information presented. As research has demonstrated in other domains, in order to make sense of the data and react, dashboard users are required to draw upon domain knowledge, higher level association between domains, operational rules, organizational missions, personal objectives, tasks at hand, priorities, past experiences, historic events, recent events, psychosocial and political constructs, and more (Resnick, 2005; Mirhaji, Srinivasan, Casscells, & Arafat, 2004). The burden of ‘interpretation’ always falls on the cognitive system of the human operator, which is prone to error and malfunctioning when risk and emergency overwhelm psychological factors (Parsa, Richesson, Smith, Zhang, & Srinivasan, 2004; Parsa, Zhang, Smith, Majid, Casscells, & Lillibridge, 2003). On the basis of the surveillance literature it can be seen that meaningful and holistic interpretation of data requires the generation of higher-level explanations based on knowledge and expertise from numerous principles (Parsa, Richesson, & Srinivasan, 2004; Parsa, Richesson, Smith, Zhang, & Srinivasan, 2004), while context is essential to illustrate the ‘big picture’ view of dynamic and complex problems (Parsa, Zhang, Smith, Majid, Casscells, & Lillibridge, 2003). These reservations imply that the process for building health information dashboards should consider not only user functions, tasks and goals but also the user’s situational awareness (SA) requirements. This vision adds a new layer to information representation that needs to be accounted for when conceptualizing the implementation of health information dashboards. A review of the literature reveals a lack of methods to design for situational awareness in dashboard systems in complex domains (Resnick, 2005; Li, 2007). This research introduces a new method to present contextualized information that can improve user SA. I present the design rationale, method, and results of an evaluation study that measures the situational awareness generated by adopting this new context-driven representation model