Computerisation and decision making in neonatal intensive care: A cognitive engineering investigation

This paper reports results from a cognitive engineering study that looked a t the role of computerised monitoring in neonatal intensive care. A range o f methodologies was used: interviews with neonatal staff, ward observations , and experimental techniques. The purpose was to investigate the sources o f information used by clinicians when making decisions in the neonatal ICU. It was found that, although it was welcomed by staff, computerised monitor ing played a secondary role in the clinicians' decision making (especially for junior and nursing staff) and that staff used the computer less often t han indicated by self-reports. Factors that seemed to affect staff use of t he computer were the lack (or shortage) of training on the system, the spec ific clinical conditions involved, and the availability of alternative sour ces of information. These findings have relevant repercussions for the desi gn of computerised decision support in intensive care and suggest ways in w hich computerised monitoring can be enhanced, namely: by systematic staff t raining, by making available online certain types of clinical information, by adapting the user interface, and by developing intelligent algorithms.