Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task.

Area of Science:

• Cognitive Science
• Health Informatics
• Clinical Decision Making

Background:

• Medication reconciliation is crucial for identifying and resolving patient medication list inconsistencies.
• The cognitive processes clinicians employ during this task remain largely undefined.
• Understanding these strategies can inform the development of human performance models for clinical tasks.

Purpose of the Study:

• To investigate the cognitive strategies utilized by clinicians during medication reconciliation.
• To determine if professional background or experience influences these strategies.
• To analyze how clinicians handle incomplete or conflicting patient information.

Main Methods:

• A tablet-based experiment involving 130 clinicians at a teaching hospital.
• Participants used a card sorting task (CaST) to organize medication and condition lists.
• Quantitative and qualitative analysis of information arrangement and response to new data.

Main Results:

• Four primary cognitive strategies were identified: 'Conditions first,' 'Medications first,' 'Crossover,' and 'Alternating.'
• Clinician experience significantly impacted strategy choice (p = .02), while profession did not.
• Clinicians demonstrated a tendency to match medications to conditions when new information was introduced.

Conclusions:

• Clinicians employ a variety of cognitive strategies during medication reconciliation.
• These strategies are influenced by individual clinician experience.
• Clinical information systems should be designed to support flexible information organization.