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oxygenation for severe adult respiratory failure

In order to provide safe and effective critical care, the bedside provider needs to have an accurate mental model of the patient – in other words a clear picture ‘in their head’ of the patient’s background, physiology and potential response to therapies or interventions. To develop a representative mental model, the provider must integrate a tremendous amount of disparate data elements in real time. Providers must skillfully process both ‘hard’ and ‘soft’ data sources, including tactile input during examination, interpersonal social clues from team members, visual and spatial input from clinical imaging, and algebraic reformulations of laboratory data.

Even the simplest clinical decisions may be impeded by poor information management leading to inaccurate mental models. Take a very low level medical management problem such as the decision to replace electrolytes based on laboratory values: when abnormal values are differentiated from normal values by color or asterisk, for example, they are less likely to be overlooked by the provider than those that are not. In this case the cognitive ergonomic factors that influence decision making are mostly confined to how the system presents an abnormal laboratory value. (Cognitive ergonomics is an applied science concerned with the interaction between systems and human end-users, as well as the design, structure, and operation of these systems in such a way as to make them safer and more efficient.) Get that wrong and providers may fail to respond appropriately to available data. Clearly, decision making in the live ICU environment can be significantly more complex than the example above. In this case a rigorous, systematic approach is required to identify the cognitive and ergonomic factors that contribute to both good and bad decision making. Once these are identified, the decision-making environment may be optimized and team performance enhanced through the integration of relevant clinical information into the workflow.

An important additional factor to consider in the ICU setting is the multidisciplinary, collaborative nature of modern practice. Physicians, nurses, and other providers will interpret the same data sources from different vantage points. This can complicate the development of a shared mental model and impair the ongoing communication that is essential to good outcomes in critical care.