Matching design to use: a task analysis comparison of three cognitive aid designs used during simulated crisis management.

ABSTRACT

PURPOSE: Intraoperative critical events typically include vital sign instability that requires a specific and time-sensitive response. Although cognitive aids can improve clinical performance during critical events, their design may not be optimized for real-world use. For example, during a critical event, health practitioners may be familiar with the treatment pathway and only require specific information from an aid-a behaviour described as "sampling". We hypothesized that use of cognitive aids designed to facilitate sampling behaviour would reduce the time required to extract information during simulated critical events. METHODS: We designed two experimental cognitive aids, based on cognitive science research on human performance, to facilitate sampling behaviour. Design principles included content clusters that were specifically located, colour-coded and labelled, the elimination of distractors such as numbering, and a key features summary. In a simulated low-fidelity study, we compared the time required for anesthesia care providers to identify and extract specific information from these two experimental cognitive aids and from a traditional step-by-step "linear/control" aid. An eye-tracking device was used to assess how information was accessed from the cognitive aids. RESULTS: When all response times were pooled, participants identified and extracted information more quickly using either experimental aid (median [interquartile range] 6.3 [4.0-9.7] sec, P = 0.006 and 4.7 [3.3-6.3] sec, P < 0.001) than the "linear/control" cognitive aid (12.7 [9.3-14.7] sec). Eye-tracking data revealed that participants spent more time looking at the "linear/control" design cognitive aid [mean (standard deviation) 10.9 (7.1) sec] than at either experimental cognitive aid [6.7 (4.6) and 3.8 (2.5) sec, P = 0.020, P < 0.001], respectively. CONCLUSION: Cognitive aids designed to enhance sampling behaviour may facilitate rapid retrieval of specific information during crisis management.