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Wilson E, Daniel M, Rao A, Torre D, Durning S, Anderson C, Goldhaber NH, Townsend W, Seifert CM. A scoping review of distributed cognition in acute care clinical decision-making. Diagnosis (Berl) 2022; 10:68-88. [PMID: 36512433 DOI: 10.1515/dx-2022-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Objectives
In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the investigation of decision-making and error.
Content
This scoping review maps the evidence collected in empiric studies applying DCog to clinical decision-making in acute care settings and identifies gaps in the existing literature.
Summary and Outlook
Thirty-seven articles were included. The majority (n=30) used qualitative methods (observations, interviews, artifact analysis) to examine the work of physicians (n=28), nurses (n=27), residents (n=16), and advanced practice providers (n=12) in intensive care units (n=18), operating rooms (n=7), inpatient units (n=7) and emergency departments (n=5). Information flow (n=30) and task coordination (n=30) were the most frequently investigated elements of DCog. Provider-artifact (n=35) and provider-provider (n=30) interactions were most explored. Electronic (n=18) and paper (n=15) medical records were frequently described artifacts. Seven prominent themes were identified. DCog is an underutilized framework for examining how information is obtained, represented, and transmitted through complex clinical systems. DCog offers mechanisms for exploring how technologies, like EMRs, and workspaces can help or hinder clinical decision-making.
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Affiliation(s)
- Eric Wilson
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Michelle Daniel
- University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - Aditi Rao
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Dario Torre
- University of Central Florida College of Medicine , Orlando , FL , USA
| | - Steven Durning
- Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Clare Anderson
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Nicole H. Goldhaber
- University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - Whitney Townsend
- Taubman Health Sciences Library , University of Michigan , Ann Arbor , MI , USA
| | - Colleen M. Seifert
- Department of Psychology , University of Michigan College of Literature, Science, and the Arts , Ann Arbor , MI , USA
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