Table 1 Knowledge deficits that must be addressed before the emergence of smart environments that facilitate reliable, safe, and compassionate delivery of appropriate interventions to hospitalized patients
Modality | Tools | Impact |
|---|---|---|
Human factors and cognitive science | Surveys Field observation Interview Chart review Standard ontology of error | Identify the human factors that contribute to diagnostic, rescue, or care delivery failures that result in excess morbidity and mortality in the ICU Identify the modes of alert that are the most effective modifi ers of behavior |
Ergonomics and engineering | Field observation Process modeling Simulation | Understand processes of care delivery Identify and eliminate environmental factors that impede the delivery of care Identify environmental artifacts that can be re-engineered to force best practice Test the impact of changes in models of care delivery Test the impact on processes of care in high-fidelity simulation environments |
Health care informatics and health information technology | Data warehousing Epidemiology Data mining Social networks | Reliably capture digital signatures of patient conditions and provider actions Build real-time feedback to systems of health care delivery (provider and manager) Facilitate the reporting of errors Facilitate secondary data use (for example, the analysis of large data sets from multiple care delivery settings) Dissemination of knowledge |
Culture | Reporting error at a local level Coordinated response of ICU community to error Lobbying Developing and enforcing standards | Knowledge of new or unanticipated errors Organized response re-enforces value of reporting Facilitate the implementation of recommendations Reform of incentives Perpetuate the safety culture |