Background

Emergency departments (EDs) are complex socio-technical work systems that require staff to manage patients in an environment of fluctuating resources and demands. To better understand the purpose, and pressures and constraints for designing new ED facilities, we developed an abstraction hierarchy model as part of a work domain analysis (WDA) from the cognitive work analysis (CWA) framework. The abstraction hierarchy provides a model of the structure of the ED, encompassing the core objects, processes, and functions relating to key values and the ED’s overall purpose.

Methods

Reviews of relevant national and state policy, guidelines, and protocol documents applicable to care delivery in the ED were used to construct a WDA. The model was validated through focus groups with ED clinicians and subsequently validated using a series of WDA prompts.

Results

The model shows that the ED system exhibits extremely interconnected and complex features. Heavily connected functions introduce vulnerability into the system with function performance determined by resource availability and prioritization, leading to a trade-off between time and safety priorities.

Conclusions

While system processes (e.g., triage, fast-track) support care delivery in ED, this delivery manifests in complex ways due to the personal and disease characteristics of patients and the dynamic state of the ED system. The model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety.

Application

The model identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.

中文翻译：

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识别日常临床实践的约束：将工作领域分析应用于急诊科护理

背景

急诊科 (ED) 是复杂的社会技术工作系统，需要工作人员在资源和需求波动的环境中管理患者。为了更好地理解设计新 ED 设施的目的、压力和约束，我们开发了一个抽象层次模型，作为认知工作分析 (CWA) 框架的工作域分析 (WDA) 的一部分。抽象层次结构提供了 ED 结构的模型，包括与关键价值和 ED 总体目的相关的核心对象、流程和功能。

方法

对适用于急诊科护理提供的相关国家和州政策、指南和协议文件的审查被用于构建 WDA。该模型通过与 ED 临床医生的焦点小组进行了验证，随后使用一系列 WDA 提示进行了验证。

结果

该模型表明，ED 系统表现出极其相互关联和复杂的特征。高度连接的功能将漏洞引入系统，其功能性能取决于资源可用性和优先级，导致时间和安全优先级之间的权衡。

结论

虽然系统流程（例如，分诊、快速通道）支持 ED 中的护理交付，但由于患者的个人和疾病特征以及 ED 系统的动态状态，这种交付以复杂的方式表现出来。该模型确定了在护理提供过程中造成紧张的系统约束（例如，电子数据输入、计算机可用性）可能危及患者安全。

应用

该模型确定了 ED 系统的各个方面，这些方面可用于通过创新的 ED 系统设计来提高 ED 性能。