The Center for Cognitive Studies in Medicine and Public Health, led by Vimla Patel, PhD, is a multidisciplinary research center devoted to evidence-based studies regarding how health professionals make decisions in complex clinical environments; the nature of medical errors; and the role of technology in mitigating errors. In 2014, the Center focused its research on improving patient safety and care quality in complex critical care environments—ICU and ER. These initiatives were driven by the goals of developing comprehensive, empirically driven interventions to mitigate clinical errors, streamline patient care transitions, and develop better protocols for patient care that integrated health information technology (HIT) seamlessly into the clinical work environment. These efforts were partly driven by a project funded by the James S. McDonnell Foundation (JSMF) on studying Cognitive Complexity and Error in Critical Care Practice. Research results from the Center’s work in 2014 appeared in numerous journals, conference publications, and in a forthcoming new book edited by Dr. Patel, Cognitive Informatics in Health and Biomedicine: Human Computer Interaction (Springer). In addition, the following projects focused on the development and evaluation of tools for clinical settings.

Care Transition and Complexity in Emergency Department: Redesigning Electronic Support

Handoffs of care between shifts is a known risk factor for medical error and adverse events.  Few electronic tools exist to support this process effectively. The objective of this study was to observe physician handoff discussions in the emergency department (ED), and to describe the relationship between clinical complexity, diagnostic uncertainty, and the content of verbal case presentations. Results indicate that as uncertainty about diagnosis and perceived illness script (?) rises, the amount of descriptive detail conveyed to the incoming physician increases. Effective novel electronic support tools should allow for dynamic adjustment to the changing needs of physicians as complexity and uncertainty levels vary.

Horsky, J., Suh, EH, Sayan, O., & Patel, V.L. (Under Review) Uncertainty and Complexity in Verbal Patient Handoffs in Emergency Department, American Medical Informatics Association (AMIA) Annual Symposium 2015.

Sensor-based Investigation of Team Interaction with Electronic Health Record in the Emergency Rooms

The Center has begun pilot testing the use of two sensor-based technologies, Radio frequency Identifier (RFID) and Bluetooth Beacons, as potential mechanisms for tracking the clinical workflow and physician activities at two EDs. The data, relying on physician locations and interactions, allows for the identification of team-based interactions, and their resulting consequences on the ED workflow. These interactions are evaluated within the context of electronic health record use.

Frisby, J. Smith, V. Patel, V. L, (Under Review) Contextual Computing: Tracking Healthcare Providers in the Emergency Department via Bluetooth Beacons. American Medical Informatics Association (AMIA) Annual Symposium 2015.

Patel, V.L. Kannampallil, T et al. (2014). Clinical Workflow and Team Activities in the Adult Emergency Room: The Role of the Electronic Health Record (EHR), Technical Report, CCSMPH, The New York Academy of Medicine.