Principal Investigator William Long
Patient care in settings such as Intensive Care Units, Trauma Resuscitation Units, Operating Rooms, Interventional Radiology and Cardiology Suites and Labor and Delivery Units is extraordinarily complex. In these settings, complexity is manifested not only in the patient and treatment protocol, but also in the high level of automation and instrumentation, the high volume of information, the interdisciplinary communication and coordination required, the urgency with which decisions and interventions must be made and the residual uncertainty associated with these decisions even when access to information is optimal. To date, there have been very few formal investigations of how these care settings function as system and how interactions between individual system components, especially diverse forms of information and emerging clinical data influence provider performance and patient safety. Specifically, we have an incomplete understanding of how the overall organization of the unit influences outcome, and how interactions and interdependencies of people, information resources, equipment resources, procedures, plans and schedules can impact patient safety. In an effort to understand more about system complexity and patient safety, we have been performing a series of studies of system complexity in the operating rooms and peri-operative units a large academic medical center. Our goals are to identify specific but previously unrecognized features of this patient care environment that influence the ability of providers to deliver a specific treatment in the intended manner and potentially compromise patient safety. We are also interested in identifying specific strategies used by individual providers and teams of providers to compensate for system constraints. With no clear knowledge of the dependent and independent variables, this type of study required an unconventional approach to clinical research.