Stress and Decision-Making in Trauma Patient Resuscitation.
Final rept. 15 May 91-14 May 96,
MARYLAND UNIV BALTIMORE ANESTHESIOLOGYRESEARCH LABS
Pagination or Media Count:
Decisionmaking in real life stressful environments is difficult to investigate yet critical to many military and civil operations. Using trauma patient resuscitation and anesthesia as a research vehicle we studied decision-making under stress in a real environment. We established video data acquisition systems in the admitting areas of a Level-l Shock Trauma Center. A multi-media database was accumulated using the system which contains videotapes of over 100 real cases, the associated medical records and audiotapes of reviews by participant and non-participant subject matter experts. A video analysis methodology was developed that includes a computer-driven video analysis system, a task-based performance measurement instrument, a recall questionnaire, and a scheme for collecting subjective stress ratings. Results of our inquiries include 1 The decision-making errors were found to have been caused by failure to follow standard operating procedures, poor communication, and faults in the system which hindered performance and promote errors. 2 Subtle clinical cues are critical to making diagnoses 3 Teams used implicit means to coordinate and many team coordination errors could be attributed to the lack of explicit communications 4 Perceived stress followed a unidimensional pattern. With the tools developed in this project, it was shown that it was feasible to collect audio-video data of decision-making and to measure stress in real environments such as trauma patient resuscitation.
- Administration and Management
- Medicine and Medical Research