title: Adaptive behaviors of experts in following standard protocol in trauma management: implications for developing flexible guidelines.
abstract: Critical care environments are complex and dynamic. To adapt to such environments, clinicians may be required to make alterations to their workflows resulting in deviations from standard procedures. In this work, deviations from standards in trauma critical care are studied. Thirty trauma cases were observed in a Level 1 trauma center. Activities tracked were compared to the Advance Trauma Life Support standard to determine (i) if deviations had occurred, (ii) type of deviations and (iii) whether deviations were initiated by individuals or collaboratively by the team. Results show that expert clinicians deviated to innovate, while deviations of novices result mostly in error. Experts' well developed knowledge allows for flexibility and adaptiveness in dealing with standards, resulting in innovative deviations while minimizing errors made. Providing informatics solution, in such a setting, would mean that standard protocols would have be flexible enough to "learn" from new knowledge, yet provide strong support for the trainees.
authors.affiliation: Arizona State University, Scottsdale, AZ, USA.
authors.forename: Mithra
authors.initials: M
authors.lastname: Vankipuram
authors.forename: Vafa
authors.initials: V
authors.lastname: Ghaemmaghami
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
mesh_terms: D000223:Adaptation, Psychological; D002983:Clinical Competence; D003422:Critical Care; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D008490:Medical Informatics; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000601:surgery / Q000628:therapy*