Complexity and Errors in Critical Care

Part of the Health Informatics book series (HI)


This volume is unique in its focus on cognitive informatics (CI), a flourishing discipline that cuts across several academic and professional sectors. The chapters in this volume focus on motivating examples drawn from the application of methods and theories from CI to challenges pertaining to the practice of critical-care medicine. Informatics is a discipline concerned with the basic and applied science of information, the practices involved in information processing, and the engineering of information systems. Cognitive Informatics is the multidisciplinary study of cognition, information and computational sciences that investigates all facets of human computing, including design and computer-mediated intelligent action [1]. The basic scientific discipline of CI is strongly grounded in the methods and theories of cognitive science. As an applied discipline, it also draws on the methods and theories from human factors and human-computer interaction. The healthcare domain has provided significant challenges and a fertile test bed for theories from these disciplines. CI provides a framework for the analysis and modeling of complex human performance in technology-mediated settings and contributes to the design and development of better information systems.


Critical Care Health Information Technology Error Recovery Critical Care Setting Shared Mental Model 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Patel VL, Kaufman DR. Cognitive science and biomedical informatics. In: Shortliffe EH, Cimino JJ, editors. Biomedical informatics: computer applications in health care and biomedicine. 3rd ed. New York: Springer; 2006. p. 133–85.Google Scholar
  2. 2.
    Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.Google Scholar
  3. 3.
    Henriksen K, Albolino S. Towards a safer healthcare system. Qual Saf Health Care. 2010;19 Suppl 3:i1–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Leape L, Berwick D. Five years after to err is human: what have we learned? J Am Med Inform Assoc. 2005;293:2385–90.Google Scholar
  5. 5.
    Berg M. Patient care information systems and health care work: a sociotechnical approach. Int J Med Inform. 1999;55:87–101.PubMedCrossRefGoogle Scholar
  6. 6.
    Leape LL. Error in medicine. JAMA. 1994;272(23):1851–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Clancey WJ. Scientific antecedents of situated cognition. In: Robbins P, Aydede M, editors. Cambridge handbook of situated cognition. New York: Cambridge University Press; 2008. p. 11–34.CrossRefGoogle Scholar
  8. 8.
    Kannampallil T, Schauer GF, Cohen T, Patel VL. Considering complexity in healthcare systems. J Biomed Inform. 2011;44(6):943–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Amalberti R. The paradoxes of almost totally safe transportation systems. Saf Sci. 2001;37(2–3):109–26.CrossRefGoogle Scholar
  10. 10.
    Rasmussen J. The role of error in organizing behaviour. Ergonomics. 1990;33:377–85.CrossRefGoogle Scholar
  11. 11.
    Patel VL, Cohen T, Murarka T, Olsen J, Kagita S, Myneni S, et al. Recovery at the edge of error: debunking the myth of the infallible expert. J Biomed Inform. 2011;44(3):413–24.PubMedCrossRefGoogle Scholar
  12. 12.
    Razzouk E, Cohen T, Almoosa K, Patel VL. Approaching the limits of knowledge: the influence of priming on error detection in simulated clinical rounds. AMIA Annu Symp Proc. 2011;2011:1155–64.PubMedGoogle Scholar
  13. 13.
    Kubose TT, Patel VL, Jordan D. Dynamic adaptation to critical care medical environment: error recovery as cognitive activity. In: Proceedings of the 24th annual meeting of the cognitive science society. Fairfax, Virginia; 2002. p. 43–4.Google Scholar
  14. 14.
    Cohen T, Blatter B, Almeida C, Patel VL. Reevaluating recovery: perceived violations and preemptive interventions on emergency psychiatry rounds. J Am Med Inform Assoc. 2007;14(3):312–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Patel VL, Zhang J, Yoskowitz NA, Green RA, Sayan OR. Translational cognition for decision support in critical care environments: a review. J Biomed Inform. 2008;41(3):413–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Patel VL, Batwara S, Myneni S, Cohen T, Gilmer A, Patel B, et al. Teamwork and error in critical care: safety in numbers? Technical Report, Center for Cognitive Studies in Medicine and Public Health, New York Academy of Medicine. April 2013.Google Scholar
  17. 17.
    Franklin A, Liua Y, Li Z, Nguyen V, Johnson RR, Robinson D, et al. Opportunistic decision making and complexity in emergency care. J Biomed Inform. 2011;44(3):469–76.PubMedCrossRefGoogle Scholar
  18. 18.
    Vankipuram M, Kahol K, Cohen T, Patel VL. Visualization and analysis of activities in critical care environments. AMIA Annu Symp Proc. 2009;2009:662–6.PubMedGoogle Scholar
  19. 19.
    Hales BM, Pronovost PJ. The checklist-a tool for error management and performance improvement. J Crit Care. 2006;21(3):231–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Kahol K, Vankipuram M, Patel VL, Smith ML. Deviations from protocol in a complex trauma environment: errors or innovations? J Biomed Inform. 2011;44(3):425–31.PubMedCrossRefGoogle Scholar
  21. 21.
    Myneni S, McGinnis D, Almoosa K, Cohen T, Patel B, Patel VL. Effective use of clinical decision support in critical care: using risk assessment framework for evaluation of a computerized weaning protocol. Annals of Information Systems (in press) [Forthcoming Special Issue on Healthcare Informatics].Google Scholar
  22. 22.
    Cohen MD, Hilligoss PB. The published literature on handoffs in hospitals: deficiencies identified in an extensive review. Qual Saf Health Care. 2010;19(6):493–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Abraham J, Kannampallil T, Patel VL. Bridging gaps in handoffs: a continuity of care approach. J Biomed Inform. 2012;45(2):240–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Morel G, Amalberti R, Chauvin C. Articulating the differences between safety and resilience: the decision-making process of professional sea-fishing skippers. Hum Factors. 2008;50(1):1–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Naikar N, Pearce B, Drumm D, Sanderson PM. Designing teams for first-of-a-kind, complex systems using the initial phases of cognitive work analysis: case study. Hum Factors. 2003;45(2):202–17.PubMedCrossRefGoogle Scholar
  26. 26.
    Arora V, Johnson J, Meltzer DO, Humphrey HJ. A theoretical framework and competency-based approach to improving handoffs. Qual Saf Health Care. 2008;17(1):11–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Vazirani S, Hays RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14(1):71–7.PubMedGoogle Scholar
  28. 28.
    Coiera EW, Jayasuriya RA, Hardy J, Banna A, Thorpe ME. Communication loads on clinical staff in the emergency department. Med J Austr. 2002;176(9):415–8.Google Scholar
  29. 29.
    Apker J, Mallak LA, Gibson SC. Communicating in the “gray zone”: perceptions about emergency physician-hospitalist handoffs and patient safety. Acad Emerg Med. 2007;14(10):884–94.PubMedGoogle Scholar
  30. 30.
    Collins SA, Bakken S, Vawdrey DK, Coiera E, Currie LM. Agreement between common goals discussed and documented in the ICU. J Am Med Inform Assoc. 2011;18(1):45–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Vimla L. Patel
    • 1
    • 2
    • 3
  • David R. Kaufman
    • 3
  • Trevor Cohen
    • 4
  1. 1.Center for Cognitive Studies in Medicine and Public Health, New York Academy of MedicineNew YorkUSA
  2. 2.Department of Biomedical InformaticsColumbia UniversityNew YorkUSA
  3. 3.Department of Biomedical InformaticsArizona State UniversityScottsdaleUSA
  4. 4.School of Biomedical InformaticsUniversity of Texas Health Science CenterHoustonUSA

Personalised recommendations