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mortality in mechanically ventilated patients

Nemeth and colleagues [15] have articulated the challenges inherent in studying the cognitive environment of health care delivery, which relies on domain-specific insights and an understanding of individual and group cognition. In seeking to deconstruct the cognitive environment of the ICU, Zhang and Norman [16] and others have invoked the theory of distributive cognition. From a systems perspective, the ICU – with its many providers, patients, physiologic monitors, diagnostic data, and family members – can be viewed as a distributed cognitive network. To understand this concept better it is helpful to think of a multidisciplinary ICU team as it goes about the business of morning rounds (Figure ​(Figure2).2). The individual members of the team examine the patient, look at the monitors and electronic records, talk to the family and each other and independently draw some conclusions from what they have observed. The team then come together, shares that knowledge and formulates a plan of care. That plan is then translated into actionable items that result in care being delivered to the patient.

As we move towards an increasingly digital environment, the traditional artifacts of communication (the paper chart, the end of bed flow sheet, handwritten orders, and so on) will be replaced by electronic alternatives. Depending on how those alternatives are designed and integrated into the acute care environment, HIT has the potential to disrupt or support the distributed cognitive function of the ICU team as it goes about its tasks. To operate effectively, an ICU team utilizing HIT requires both optimal functioning of providers and electronic artifacts and durable mechanisms of coordination. Individual members must understand their individual roles, the broader system, and how they fit within it. Additionally, teams need to develop shared mental models, articulate clear goals, and remain vigilant for new developments. Failure to perform in any of these areas can result in communication breakdown, error and patient harm.