Journal
JOURNAL OF BIOMEDICAL INFORMATICS
Volume 38, Issue 3, Pages 200-212Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.jbi.2004.11.012
Keywords
decision making; devices; critical care collaborative decision making; patient safety; individual/group expertise; task analysis; institutional decision making
Funding
- NLM NIH HHS [G08 LM07676] Funding Source: Medline
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This paper presents the perspectives of personnel involved in decision-making about devices in critical care. We use the concept of sharp and blunt ends of practice to describe the performance of health care professionals. The sharp end is physically and temporally close to the system; the blunt end is removed from the system in time and space and yet affects the system through indirect influence on the sharp end. In this study, the sharp end is represented by the clinicians (nurses and doctors) and the blunt end by the administrators and biomedical engineers. These subjects represent the professionals involved in the decision-making process for purchasing biomedical equipment for the hospital. They were asked to think aloud while evaluating three error scenarios based on real events. The responses were recorded and transcribed for analysis. The results show differences in interpretation of critical events as a function of professional expertise. The clinicians (sharp-end practitioners) focused on clinical and human aspect of errors while the biomedical engineers focused on device-related errors. The administrators focused on documentation and training. These different interpretations mean that the problems are represented differently by these groups of subjects, and these representations result in variable decisions about devices. These results are discussed within a systems approach framework to help us assess the completeness of the problem representations of the subjects, their awareness of critical events, and how these events would collectively contribute to the occurrence of error. (c) 2004 Elsevier Inc. All rights reserved.
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