Graduate Seminar Series: Clinical Stream – Azadeh Assadi

Graduate Seminar Series: Clinical Stream
Graduate Seminar Series for the Institute of Biomedical Engineering (BME). This day is for clinical stream presenters.
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Presentation Title: Applying clinician macrocognition in designing decision support
Abstract:
Introduction: Compared to children without congenital heart disease (CHD), those with CHD
experience a significantly higher hospital admission, morbidity, and mortality associated with
their acute presentation to the emergency department (ED). The burden of residual lesions and
the natural history of many CHDs predisposes these children to hemodynamic fragility with
common childhood illnesses and altered response to traditional resuscitative measures. Their
optimal outcome requires CHD-expertise which is limited in local EDs. Hence, there is an urgent
need for a sociotechnological solution to support the management of these patients in the ED. In
this study, a CHD-specific clinical decision support system (CDSS) is developed and evaluated
based on CHD-experts and ED physicians’ macrocognition.
Methods: Using the critical decision method, a cognitive task analysis (CTA) of CHD-experts
and ED physicians was conducted to understand their macrocognitive differences when
managing acutely ill pediatric CHD patients. Framework analysis was then used to identify key
decision requirements and design concepts to design the prototype CDSS using decision centered
design. Heuristic and usability testing was completed on versions of the proposed CDSS while the effect of the CDSS on ED physicians’ decision making was tested using a scenario-based
simulation study.
Results: The most pertinent differences in decision making between CHD-experts and ED
physicians were in sensemaking, anticipation, and managing complexity. Accordingly, the key
decision requirements and design concepts incorporated into the prototype CDSS involved
appreciating the CHD physiology, identifying CHD-specific diagnoses, and selecting
appropriate CHD interventions. Use of the CDSS significantly improved ED physicians’ CHDspecific decision-making (M= 5.43, 95%CI 3.7-7.2).
Conclusion: This study reveals differences in CHD-expert and ED physicians’ macrocognition
and decision making while also proposing a design approach to develop and evaluate a CHDspecific CDSS. These findings can be used to design other sociotechnological solutions to
support the care of pediatric CHD patients.
Supervisor Name: Patricia Trbovich
Year of Study: 5
Program of Study: PhD
Zoom link: https://us02web.zoom.us/j/89610372821?pwd=azd4SCtYVWtreVovaGNPV1c2NGY2Zz09
Meeting ID: 896 1037 2821
Password: 483329
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