Presentation
Approaches to decision making vary across types of emergent patient scenarios
SessionLBR4: Late Breaking Results
DescriptionBackground/Objective: Acute management of critical events is needed to save lives. We used high-fidelity simulation to explore clinician decision-making during crisis events. Explore how diverse challenges within dynamic high-risk simulated scenarios affect anesthesiologists’ decision making.
Method: We designed four high-fidelity simulation scenarios involving complex challenging situations in perioperative care (e.g., acute decompensation requiring life-saving interventions). Anesthesiologists volunteered to perform in all four scenarios in one day. After each simulation, participants were interviewed using applied cognitive task analysis methods. Cognitive probes targeted 3-5 participant-identified ‘key events’, focusing on important cues, assessments, and actions. Transcribed interviews were coded in Dedoose™.
Results: We identified different aspects of decision-making based on the challenges presented in each scenario (e.g., clinical vs. behavioral) between participants. For example, in a scenario with a complicated paraplegic patient who becomes more hemodynamically unstable and unresponsive, participants described treatment goals (e.g., decrease the heart rate) and mental simulation (e.g., what they would need for intubation) more frequently than in the other scenarios. Conversely, in a scenario requiring management of a fixated colleague (an actor) whose interventions caused further patient deterioration, participants more often described temporizing (e.g., treating seizure empirically without knowing cause) and rule-based (e.g. following established but sometimes inappropriate) protocols.
Takeaways: This study suggests cognitive interviews could be useful in providing insights into cognitive processes used to manage different clinical challenges. Findings have implications for training and decision aid design to support acute high-risk decision-making.
Method: We designed four high-fidelity simulation scenarios involving complex challenging situations in perioperative care (e.g., acute decompensation requiring life-saving interventions). Anesthesiologists volunteered to perform in all four scenarios in one day. After each simulation, participants were interviewed using applied cognitive task analysis methods. Cognitive probes targeted 3-5 participant-identified ‘key events’, focusing on important cues, assessments, and actions. Transcribed interviews were coded in Dedoose™.
Results: We identified different aspects of decision-making based on the challenges presented in each scenario (e.g., clinical vs. behavioral) between participants. For example, in a scenario with a complicated paraplegic patient who becomes more hemodynamically unstable and unresponsive, participants described treatment goals (e.g., decrease the heart rate) and mental simulation (e.g., what they would need for intubation) more frequently than in the other scenarios. Conversely, in a scenario requiring management of a fixated colleague (an actor) whose interventions caused further patient deterioration, participants more often described temporizing (e.g., treating seizure empirically without knowing cause) and rule-based (e.g. following established but sometimes inappropriate) protocols.
Takeaways: This study suggests cognitive interviews could be useful in providing insights into cognitive processes used to manage different clinical challenges. Findings have implications for training and decision aid design to support acute high-risk decision-making.
Event Type
Late Breaking Results
TimeFriday, September 13th9:55am - 10:05am MST
LocationFLW Salon B