A Cognitive Task Analysis for Developing a Clinical Decision Support System for Emergency Triage.

Area of Science:

• Emergency Medicine
• Health Informatics
• Human Factors Engineering

Background:

• Emergency Department (ED) triage is critical for patient prioritization and resource allocation.
• Triage nurses make rapid, high-pressure decisions influenced by cognitive factors and environmental challenges.
• Understanding these complexities is key to improving patient safety and care quality.

Purpose of the Study:

• To explore the multifaceted nature of triage decision-making by nurses.
• To identify influencing factors, cognitive processes, and real-world challenges in ED triage.
• To lay the groundwork for developing effective Clinical Decision Support Systems (CDSS).

Main Methods:

• Cognitive task analysis using interviews and observations.
• Capturing cognitive strategies employed by nurses during patient triage.
• Gaining detailed insights into acuity assessment, uncertainty management, and decision verification.

Main Results:

• 26 themes identified, showing nurses use experience and protocols (e.g., Emergency Severity Index).
• Key challenges include overcrowding, staff shortages, high patient acuity, communication barriers, interruptions, and multitasking.
• Nurses adapt through prioritization and collaboration despite significant hurdles.

Conclusions:

• Improvements in triage decision-making, resource utilization, and patient safety are needed.
• Data-driven CDSS can enhance decision-making, streamline assessments, and reduce delays.
• CDSS can improve safety and equity in triage, especially in high-stress, resource-constrained settings.