Computerisation and complex decision making : a cognitive investigation in the domain of intensive care
Technological advances in the medical domain have dramatically changed the quality of Medical Decision Making (MDM). Computerised Monitoring Systems (CMSs) are amongst the techniques that are used to support medical decisions and reduce some human errors such as decision biases. However, previous research suggested that the CMS did not accomplish objectives, improving MDM in Intensive Care Units (ICU). Cognitive psychology played an important role in the design of the CMS using a range of techniques, such as experiments and interviews. In the current study, a questionnaire on the usability of the CMSs was designed and validated to measure different variables related to the usability of the CMS. This questionnaire was used in study 1 in an ICU ward in Edinburgh and results showed acceptable levels of validity and reliability. This study was replicated in another 3 studies in 4 ICU wards in the UK (Gillingham and Birmingham), and in India. Results showed that (i) the clinical staff varied reporting the use and usability of the CMS, (ii) the staff use the CMS for certain types of medical decisions, (iii) the most used facilities on the system across all wards were the physiological functions, (iv) clinical expertise played an important role in the use and usability of the CMS, (v) the usability of the CMS was affected by clinical expertise, specialty, types of medical decisions, and purposes for which the CMS are used, (vi) results were mostly consistent in all places, (vii) the CMS played a secondary role as a source of information staff consult while making decisions, (viii), there were significant correlations among various aspects of usability related variables (e.g. experience at ICUs and purposes for which they use the CMS). The findings suggested a lack of understanding of the clinical staff’s cognition. This suggested further experimental investigations of the medical cognition in the ICU settings. Five experiments, using real-life medical problems based on patients in ICU wards (babies & adults) on ICU doctors at two levels of expertise (seniors & juniors) were carried out. These explored some of the typically debated or rarely addressed issues in medical cognition. Results revealed that: (i) medical expertise played a prominent role in MDM under uncertainty in terms of the amount of risk to be taken and decision time, (ii) the doctors were considerably influenced by the level of uncertainty under which they made MDs, (iii) increasing the level of risk increased MD time, (iv) the framing of medical decisions had a partial impact on the risk taking while MDM, and on decision time, (v) the content of decision problems affected the risk taking, but did not affect the decision time, and (vi) overloading the storage capacity of working memory influenced MD time but did not influence the risk taking, (vii) imposing demands on the central executive (CE) component of WM strongly resulted in doctors taking more risky decisions, and increased decision time, and (viii) the affect of the CE load varied with expertise and level of risk.