• Amy Franklin, Ying Liu, Zhe Li, Vickie Nguyen, Todd R Johnson, David Robinson, Nnaemeka Okafor, Brent King, Vimla L Patel, and Jiajie Zhang.
• Center for Cognitive Informatics and Decision Making, School of Health Information Sciences, The University of Texas Health Science Center at Houston, 7000 Fannin, Houston, TX 77030, USA. Amy.Franklin@uth.tmc.edu
• J Biomed Inform. 2011 Jun 1;44(3):469-76.

AbstractIn critical care environments such as the emergency department (ED), many activities and decisions are not planned. In this study, we developed a new methodology for systematically studying what are these unplanned activities and decisions. This methodology expands the traditional naturalistic decision making (NDM) frameworks by explicitly identifying the role of environmental factors in decision making. We focused on decisions made by ED physicians as they transitioned between tasks. Through ethnographic data collection, we developed a taxonomy of decision types. The empirical data provide important insight to the complexity of the ED environment by highlighting adaptive behavior in this intricate milieu. Our results show that half of decisions in the ED we studied are not planned, rather decisions are opportunistic decision (34%) or influenced by interruptions or distractions (21%). What impacts these unplanned decisions have on the quality, safety, and efficiency in the ED environment are important research topics for future investigation.Copyright © 2011 Elsevier Inc. All rights reserved.

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