Improving Clinical Decision Making Through Ecological Interfaces

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Improving Clinical Decision Making Through
Ecological Interfaces

• Judith Effken
• University of Arizona
• College of Nursing

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Our piece of the puzzle Improving clinical
decisions in ICUs

• Clinicians integrate over 2000 data elements per
  patient per day to make clinical decisions
• Experts detect and select key information
• Novices - a sequential search process

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Clarifying the Problem Cognitive Work Analysis
(Vicente, 1999).
Clinician Skills
Social/Organizational Issues
Strategies Diagnosis, Treatment
Task Diagnosis, Treatment
Domain Oxygenation Management
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Basic Analysis

• Work Domain CWA
• Task Goals Strategies Decision Ladder
• Social-organizational Observation
• Skills Interviews

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Carpers Ways of Knowing

• Empirical Data, control tasks, objects
• Ethical Accuracy, reliability, cultural values
  encourage effective strategies
• Personal Organization, discipline, workgroup
  novice-expert, individual differences
• Aesthetic Meaning derived from data, control
  tasks, etc.

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Results A 4-level Oxygenation Process
Purposes Balances Processes Physiolo
gy
Cellular Oxygen
Oxygen Delivery
Oxygen Consumption
Infection, Exercise, etc.
Cardiac Output
Oxygen Content
SaO2
Hgb
Heart Rate
Stroke Volume
After Load SVR
Pre Load PAWP
Contractility LV EDV
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Design Challenges

• Missing sensor (cellular oxygen)
• Few higher order invariants
• A biological vs. abstract display
• Capturing changes over time

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From Analysis to Design
Portion of the Ecological Display (ED) showing
relationships of SaO2 and Hgb to CaO2 (object
area)
Portion of the Traditional Bargraph Display
(TD)
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Evaluation Diagnostic Treatment Accuracy

• Ecological
• organizes information in way that experts use it
• Maps relationships onto geometry
• Comparison 1 Numeric display
• Comparison 2 Bar graph display
• Alternate 1
• organized by way data collected
• Alternate 2
• organized in way that experts use it

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Major Results

• Ecological gt numeric display
• Gist
• No degradation for specific values
• Metaphors are risky
• Ecological Alternate 2 gt Alternate 1
• Data organization makes a difference in control
• More impact on residents than nurses
• The need for
• Temporal dimension
• Real estate conservation
• Layered displays

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Questions?