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'Attention on the flight deck': What ambulatory care providers can learn from pilots about complex coordinated actions

机译：“对驾驶舱的注意”：卧床护理提供者可以向飞行员学习哪些有关复杂协调行动的信息

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摘要

Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Results: Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. Conclusion: We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. Practice implications: Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.
机译：目的：在门诊医疗中使用电子健康记录（EHR）的技术和人际挑战仍然存在。我们将座舱通讯作为飞行过程中高度协调的复杂活动的示例，并将其与考场中使用计算机时提供商的通讯进行比较。方法：采用最大变异采样法从一级保健医师检查室计算机的一项父项研究中确定两个录像带，这些录像带显示出最大变异。然后，我们生成并分析了提供者花在看计算机和看病人身上的时间的可视化。结果：与设计用于在复杂的协调活动中优化联合注意力的座舱不同，我们发现在利用联合注意力集中来管理医疗事故时出现了极端情况。结论：我们的结论是，在常规的非卧床就诊中，在检查室中装有计算机的情况下，存在很大的空间来改善人际和技术关注的平衡。实践意义：采用众所周知的航空实践可以帮助初级保健提供者更多地意识到在检查室计算时代加强医师与患者之间关系的机遇和挑战。

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