Informing Digital Cognitive Aids Design for Emergency Medical Work by Understanding Paper Checklist Use

Abstract

We examine the use of a paper-based checklist during 48 simulated trauma resuscitations to inform the design of digital cognitive aids for safety-critical medical teamwork. Our analysis focused on team communication and interaction behaviors as physician leaders led resuscitations and administered the checklist. We found that the checklist increased the amount of communication between the leader and the team, but did not compromise the leader's interactions with the environment. In addition, we observed several changes in team dynamics: the checklist facilitated collaborative decision making and process reflections, but it also made some team members reactive rather than proactive. As the push toward digitizing medical work continues, we expect that paper checklists will soon be replaced by their digital counterparts. Designing interactive cognitive aids for medical domains, however, poses many challenges. Our results offer directions for how these tools could be designed to support medical work in increasingly digital environments.