AMIA Annu Symp Proc - Adaptive behaviors of experts in following standard protocol in trauma management: implications for developing flexible guidelines.

Tópicos

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{ data(3963) clinic(1234) research(1004) }
{ record(1888) medic(1808) patient(1693) }
{ patient(1821) servic(1111) care(1106) }
{ implement(1333) system(1263) develop(1122) }
{ data(1714) softwar(1251) tool(1186) }
{ research(1218) medic(880) student(794) }
{ detect(2391) sensit(1101) algorithm(908) }
{ error(1145) method(1030) estim(1020) }
{ state(1844) use(1261) util(961) }
{ can(981) present(881) function(850) }
{ system(1976) rule(880) can(841) }
{ chang(1828) time(1643) increas(1301) }
{ control(1307) perform(991) simul(935) }
{ howev(809) still(633) remain(590) }
{ result(1111) use(1088) new(759) }
{ decis(3086) make(1611) patient(1517) }
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{ activ(1452) weight(1219) physic(1104) }
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{ patient(2315) diseas(1263) diabet(1191) }
{ take(945) account(800) differ(722) }
{ motion(1329) object(1292) video(1091) }
{ assess(1506) score(1403) qualiti(1306) }
{ treatment(1704) effect(941) patient(846) }
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{ clinic(1479) use(1117) guidelin(835) }
{ algorithm(1844) comput(1787) effici(935) }
{ extract(1171) text(1153) clinic(932) }
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{ design(1359) user(1324) use(1319) }
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{ case(1353) use(1143) diagnosi(1136) }
{ studi(1410) differ(1259) use(1210) }
{ perform(999) metric(946) measur(919) }
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{ system(1050) medic(1026) inform(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ monitor(1329) mobil(1314) devic(1160) }
{ ehr(2073) health(1662) electron(1139) }
{ patient(2837) hospit(1953) medic(668) }
{ age(1611) year(1155) adult(843) }
{ medic(1828) order(1363) alert(1069) }
{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ first(2504) two(1366) second(1323) }
{ intervent(3218) particip(2042) group(1664) }
{ time(1939) patient(1703) rate(768) }
{ use(2086) technolog(871) perceiv(783) }
{ analysi(2126) use(1163) compon(1037) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ survey(1388) particip(1329) question(1065) }
{ estim(2440) model(1874) function(577) }
{ method(1969) cluster(1462) data(1082) }
{ method(2212) result(1239) propos(1039) }

Resumo

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. In this work, deviations from standards in trauma critical care are studied. Thirty trauma cases were observed in a Level 1 trauma center. 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 show that expert clinicians deviated to innovate, while deviations of novices result mostly in error. Experts' well developed knowledge allows for flexibility and adaptiveness in dealing with standards, resulting in innovative deviations while minimizing errors made. Providing informatics solution, 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.

Resumo Limpo

critic care environ complex dynam adapt environ clinician may requir make alter workflow result deviat standard procedur work deviat standard trauma critic care studi thirti trauma case observ level trauma center activ track compar advanc trauma life support standard determin deviat occur ii type deviat iii whether deviat initi individu collabor team result show expert clinician deviat innov deviat novic result most error expert well develop knowledg allow flexibl adapt deal standard result innov deviat minim error made provid informat solut set mean standard protocol flexibl enough learn new knowledg yet provid strong support traine

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