Designing Digital Healthcare Technology to Support Cognitive Team Work in Pediatric Trauma Settings

Conveying critical information amidst chaos

Trauma is the leading cause of death and permanent paralysis among children. In a Level I pediatric trauma care center, where diagnosis and treatment care and decisions are chaotic and timesensitive, an average of 60 different roles may be taking care of a patient at some point during their stay in the hospital. For example, as many as 20 care providers may show up in a pediatric ED trauma bay in minutes depending on the severity of the patient’s condition. Professional care roles include physicians (emergency medicine, anesthesiology, general surgery), nurses, respiratory therapists, pharmacists, case managers, social workers, and other sub-specialties depending on the needs of the child. Each needs to know what has happened: the initial incident, the current clinical condition including what has been done so far (in terms of diagnosis and treatment), and what the next steps are (e.g., surgery, transfer). It is imperative that each role coordinates and communicates their patient assessment and plan across other care team members as they cycle in and out of the individual’s trauma bay.

But how is information shared in the fast-paced, high-stress and high-consequence environment of the trauma bay? Dr. Ayse Gurses, a human factors engineer, says it is usually through searching for a familiar face, such as another physician or nurse, who has already arrived to the trauma bay and busy taking care of the child and asking them about what happened to the child, what the current clinical condition is, and what the plan is. However, these colleagues may not be available as they are also trying to take care of the child and it may be dangerous to interrupt them when it pertains to making what may be life-saving decisions for which every minute is precious.

Optimizing information presentation using graphic displays

Dr. Gurses and her team wanted to find a better way to support the information-sharing process and cognitive team work with the use of technology. Through multiple qualitative studies guided by human factors and systems engineering approaches, they interviewed and conducted design sessions with pediatric trauma staff to understand and facilitate the cognitive processes at play in this chaotic and highpaced environment. Their input and feedback informed the iterative development of graphic displays to present key patient clinical data and trends to trauma bay staff. The process was highly participatory on purpose because the team was designing technology for people with an array of roles and information needs.

“The trauma surgeon may want to see some clinical data point or representation that is different from the anesthesiologist and the nurse, and vice versa. In the process, we learned how different specialties’ thinking processes and perspectives differ, and designed the technology accordingly to support them individually and as a team.”
- Dr. Ayse Gurses

Conveying critical information more reliably and efficiently with well-designed, large-format graphic displays

Human-centered design takes time but pays off. Pediatric trauma staff, who participated in the studies found the dashboard useful, agreed that it would support situational awareness and would likely improve both patient safety and efficiency.

This research improved the understanding of the cognitive processes of pediatric care teams and advanced knowledge of digital design elements to support them.

The evaluation also elucidated important design feedback and improvement opportunities. “It is possible to design technology that will support team work and patient safety while also reducing care professional workload and stress, which is amazing,” said Dr. Gurses.