Decision Making for Patient Safety in Critical Care Equipment Selection

Injuries resulting from medical device use errors far exceed injuries arising from device failures. Until recently, human factors issues have received relatively little attention in medicine. Although the situation is gradually changing, many devices that are currently on the market are suboptimal from the human factors perspective. This situation places significant responsibility for the device interface quality on the purchasers. Research on the influence of usability considerations on device purchasers’ decision making could provide valuable theoretical foundation for designing medical device selection guidelines. Medical device selection is a complex team decision making process that involves individuals with varying levels of specialized knowledge, and may reflect a number of individual and group biases. Klein and colleagues describe several aspects of team cognition and metacognition that distinguish successful teams (for review, see Klein, 1998). They suggest that successful teams are characterized by experience, stability and coherence. Members of such teams have common goals and share understanding of the situation. They use their “collective intelligence” to monitor their performance. In medicine, success of team functioning is related to similar decision-making characteristics (Patel, et al. 2002). This paper describes a retrospective analysis of an infusion pumps purchase in a large urban hospital system and focuses on cognitive and organizational factors in the decision making process. The study involved a) semistructured interviews with nine participants in the latest infusion pumps purchase in a major urban hospital system, and b) analysis of documents relevant to the purchase. The data analysis was based on several formal qualitative analytic methods, including thematic coding and semantic analysis.