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

Abstract

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. 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. 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. Cognitive aids designed to enhance sampling behaviour may facilitate rapid retrieval of specific information during crisis management.