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BEGIN:VEVENT
DTSTAMP:20260715T161118Z
LOCATION:Rhinelander Gallery
DTSTART;TZID=America/New_York:20260324T164500
DTEND;TZID=America/New_York:20260324T181500
UID:HFESHCS_2026 International Symposium on Human Factors and Ergonomics i
 n Health Care_sess111_POST272@linklings.com
SUMMARY:Data Aquisition In The Emergency Room, It Is Harder Than You Think
 !
DESCRIPTION:Meagan Ladell and Kimberlee Suenkens (Medical College of Wisco
 nsin), Elizabeth Papautsky (University of Illinois Chicago), and Matthew S
 canlon (Medical College of Wisconsin)\n\nBackground/Introduction: \nDiagno
 stic failure is an area of patient safety in which much of the literature 
 is either retrospective or based on expert opinion. The literature primari
 ly cites faulty cognitive processes including shortcomings of physicians w
 ith information gathering and synthesis as major contributors to diagnosti
 c breakdowns, however these conclusions have been based on discussions clo
 ser to the realm of work as imagined (WAI) with lack of understanding of w
 ork as done (WAD). To close the gap between WAI and WAD, we sought to furt
 her understanding of how physicians gather information by completing a pro
 spective observational study of physicians in the pediatric emergency depa
 rtment, a clinical arena chosen for its diagnostically dense work. Through
  a data collection tool created and inspired by the Systems Engineering In
 itiative for Patient Safety (SEIPS) model, we recorded and timed tasks phy
 sicians were doing along with who was present and what tools were utilized
  with a goal of illustrating the complexity of diagnostic work being compl
 eted.  The aim of this study was to observe how physicians acquire informa
 tion about patients to gain understanding and insights into diagnostic wor
 k not captured with retrospective methods. \n\nMethods: \nIn the pediatric
  emergency department, four-hour blocks of direct observations of the atte
 nding physicians were completed in the summer of 2023.  A novel tool was c
 reated in REDCap and designed using the lens of SEIPS to capture informati
 on including tasks completed, timing of those tasks, interactions with peo
 ple, tools/technology used, and location where it took place. This data wa
 s captured in context of arbitrarily selected patients, labeled as the “in
 dex patients” from the moment the physician heard the patient’s story thro
 ugh the first 50 minutes of diagnostic work. Any work observed for patient
 s other than index patient was labeled as “other patients.” The tasks reco
 rded were categorized into data acquisition as a known component of diagno
 stic work, with the other tasks being categorized as other or therapeutic.
   \n\nResults: \nWe observed 26 attending physicians caring for 66 index p
 atients. We captured 2,836 tasks. Physicians took histories for only a sub
 set (65%, 43/66) of the 43 patients (M = 1.5 min, Median = 1.3 in duration
 ).   About 66% of physician time was spent completing information acquisit
 ion necessary for diagnostic work, and 33% doing therapeutic work.  We doc
 umented and characterized a multitude of information sources including ele
 ctronic health record (EHR) (and embedded tools/apps), non-EHR related tec
 hnology, health care personnel, and the patient/family. The most common ta
 sks used to gather information were performing a physical exam, staffing a
  patient, and taking a history, and less commonly recorded than expected w
 as the task, ‘reading about the patient’ in the EHR. Instead, we observed 
 with the EHR used primarily while the physicians were hearing about the pa
 tient from the resident or advanced practice provider (APP).  We represent
 ed findings of in a bubble chart illustrated a wide distribution of source
 s collected between EHR related sources, other personnel, and the family. 
   \n\nConclusion: \nDiagnosis is a process that is not a straightforward “
 data in, data out’ process.  Our results show the complexity of what is re
 quired to acquire diagnostic information, and it is different from what yo
 u expect. In fact, we found that to perform diagnostic work a history take
 n from the patients was not necessarily required.  What we did find was an
  impressive distribution of sources between people, EHR -related technolog
 ies, and non-EHR related technology.\n\nTrack: Digital Health, Hospital En
 vironments, Patient Safety Research and Initiatives, Medical and Drug Deli
 very Devices, Simulation and Education\n\n
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