Analysis of Deviations in Complex Adaptive Systems
SUMMARY: Critical care environments are complex and dynamic. To adapt to such environments, clinicians may be required to make alterations to their workflows resulting in deviations from standard procedures. Some of these deviations are errors which can result in harmful outcomes. On the other hand, some of the deviations can be innovations, which are dynamic adjustments to the protocols made by people to adapt the current operational conditions and achieve high accuracy and efﬁciency. However, there is very little known about the underlying cognitive processes that are related to errors and innovations. In this work, deviations from standards in trauma critical care are studied.
METHODS: Field observations were conducted in a Level 1 Trauma unit. A total of 30 Trauma cases were observed and the collected data was analyzed using measures that included customized activity-error-innovation ontology, time-stamps and expertise of the team members. Activities tracked were compared to the Advance Trauma Life Support standard to determine (i) if deviations had occurred, (ii) type of deviations and (iii) whether deviations were initiated by individuals or collaboratively by the team. Results showed that expert clinicians deviated to innovate, while deviations of novices result mostly in error.
CONCLUSIONS: Experts’ well-developed knowledge allows for flexibility and adaptiveness in dealing with standards, resulting in innovative deviations while minimizing errors made. Providing informatics solutions, in such a setting, would mean that standard protocols would have be flexible enough to “learn” from new knowledge, yet provide strong support for the trainees.
STATUS: In Publishing
- [BOOK CHAPTER] Vankipuram M, Ghaemmaghami V, Patel VL, “Adaptive Behaviors in Complex Clinical Environments”, Cognitive Informatics in Health and Biomedicine: Case Studies on Critical Care, Complexity and Medical Error, Springer, N.Y. [IN DRAFT]
- [CONFERENCE PROCEEDINGS] Vankipuram M, Ghaemmaghami V, Patel VL, “Adaptive Behaviors of Experts in Following Standard Protocol in Trauma Management: Implications for Developing Flexible Guidelines”, American Medical Informatics Association (AMIA) Annual Symposium, (2012). [Download PDF]
- [DISSERTATION] Vankipuram M, “Understanding Adaptive Behaviors in Complex Clinical Environments”, Arizona State University, (2012); Submitted for completion of Ph. D. Biomedical Informatics. [Download PDF]
- [JOURNAL ARTICLE] Kahol K*, Vankipuram M*, Patel VL, Smith ML, “Deviations from Protocol in a Complex Trauma Environment: Errors or Innovations?”, J Biomedical Informatics, (2011); 44(3): 425-31. [Download PDF]
* Equal contribution by authors for the publication.