Deviations from protocol in a complex Trauma environment

Errors or innovations?

Kanav Kahol, Mithra Vankipuram, Vimla Patel, Marshall L. Smith

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Protocol standardizations are important for consistent and safe practices. However, complex clinical environments are highly dynamic in nature and often require clinicians, confronted with non-standard situations, to adjust and deviate from standard protocol. 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 study we investigate the extent to which deviations are classified as errors or innovations, as a function of expertise in a Trauma setting. Field observations were conducted in a Level 1 Trauma unit. A total of 10 Trauma cases were observed and collected data was analyzed using measures that included customized activity-error-innovation ontology, timestamps and expertise of the team members. The results show that expertise of the caregivers and criticality of a patient's condition in critical care environment influence the number and type of deviations from standard protocol. Experts' deviations were a combination of errors and innovations; whereas the novices' deviations were mostly errors. This research suggests that a novel approach must be taken into consideration for the design of protocols (including standards) and compliance measurements in complex clinical environments.

Original languageEnglish (US)
Pages (from-to)425-431
Number of pages7
JournalJournal of Biomedical Informatics
Volume44
Issue number3
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

Fingerprint

Innovation
Network protocols
Wounds and Injuries
Trauma Centers
Critical Care
Caregivers
Compliance
Standardization
Ontology
Research

Keywords

  • Complexity
  • Errors
  • Innovations

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics

Cite this

Deviations from protocol in a complex Trauma environment : Errors or innovations? / Kahol, Kanav; Vankipuram, Mithra; Patel, Vimla; Smith, Marshall L.

In: Journal of Biomedical Informatics, Vol. 44, No. 3, 01.06.2011, p. 425-431.

Research output: Contribution to journalArticle

Kahol, Kanav ; Vankipuram, Mithra ; Patel, Vimla ; Smith, Marshall L. / Deviations from protocol in a complex Trauma environment : Errors or innovations?. In: Journal of Biomedical Informatics. 2011 ; Vol. 44, No. 3. pp. 425-431.
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