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NYAM’s Center for Cognitive Studies in Medicine and Public Health (CCSMPH), led by Dr. Vimla Patel, is a multidisciplinary research unit devoted to evidence-based studies regarding how health professionals make decisions in complex clinical environments and the nature of errors that may be generated, as well as the role of technology in mitigating errors. The Center’s work draws on theories from cognitive and social sciences, which include cognitive psychology, linguistics, philosophy, decision sciences, and computer science, to further our understanding of human behavior. The Center’s research is guided by the overarching goals of developing new approaches and best practices for safe, effective, and efficient clinical environments. Toward this end, CCSMPH research focuses on the cognitive characteristics (memory, knowledge, strategies) involved in changing behavior, learning, and designing effective decision-support and other health information technologies for safe clinical practice.
“You may ask how these cognitive studies relate to NYAM’s focus on urban health,” Dr. Patel said. “Cognitive studies identify the nature of complex health and healthcare environments, including the problems that arise due to such complexity. Although the current work focuses on critical care, the results are generic and are transferable to any other complex environment.”
Dr. Patel explains that urban health care is incredibly complex and presents a unique set of challenges in disease prevention, assuring healthy lifestyles, and delivering quality care. The Center’s research informs ways to mitigate these challenges by reducing (where possible) or otherwise managing complexity.
One of the major findings from the Center’s research on decision-making in critical-care settings has shown the paucity of current evaluation methods and measures to capture the intricate nature of complex critical-care work activities. The Center’s current research builds not only on developing new methods, but also testing them to assess their effects in the clinical work environment. The role of health information technology plays a major role in most of this research.
In 2012, the Center worked on a number of strategic initiatives that centered on improving patient safety and care quality in complex critical-care environments. These initiatives were driven by the goals of developing comprehensive, empirically driven interventions that reduce clinical errors, streamline patient-care transitions, develop better protocols for patient care, and integrate health information technology safely in the clinical work environment. This focus was partly driven by a project funded by the James S. McDonnell Foundation (JSMF) on studying Cognitive Complexity and Error in Critical-Care Practice.
The Center’s evidence-based research has formed the basis for multiple clinical interventions that have been shown to improve clinical work activities. Two interventions conducted in partnership with the University of Texas-Houston are a virtual reality training program for residents for correcting and recovering from errors and a set of new clinical protocols for respiratory therapists to assist with weaning patients off artificial respiration.
Another successful intervention centered on a new patient-care transition tool that outlines what information doctors should pass to others between hospital shifts in order to reduce information loss. The intervention study shows a significant reduction in information loss as well as a reduction in other types of errors.
The Center also partnered with the Banner Health System and Arizona State University on a trauma unit study that asked the question, “When do doctors deviate from an evidence-based protocol?” The study found that more experienced doctors with better training were more likely to deviate from protocols in positive, innovative ways rather than potentially detrimental ones. The intervention involved the development of a decision-support tool for trainees with the use of an iPad.
A recent intervention study conducted in collaboration with Banner Health System in Arizona and Memorial Hermann Hospital in Texas used tracking devices in the ICU and ER—individual Radio Frequency Identifier Detector (RFID) electronic tags that doctors carry in their pockets—that allow tracking of their movements during interactions. This information is useful in determining how doctors can most efficiently distribute their tasks in order to reduce errors and to enhance the quality of communication.
Research results from the Center’s work have appeared in numerous journals and conference publications, including a number of invited addresses. One of the papers on the evaluation of a patient-care transition tool received the distinguished paper award from the American Medical Informatics Association, the premier professional society of clinical informatics researchers and practitioners. The Center has also been represented in a number of national and international meetings on health information technology, patient safety, clinical errors, and decision support.
"As the lessons of these studies are recognized and changes are adopted, we will see great improvements in health care—not only in critical-care settings but also with the wide variety of health-related concerns that characterize the complex urban environment," Dr. Patel said.
Posted on August 13, 2013
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