The number of medical errors that occur each year is staggering. When the details of these errors are investigated, it is often discovered that there are a variety of factors and people that contributed to the poor decision - not just one single person or procedure. Many of these errors could be mitigated by improving communication and coordination among the medical staff.

Klein Associates was hired by a large urban hospital in Minneapolis, MN to develop training for their Emergency Department staff. Based upon data gathered through Team Cognitive Task Analysis interviews with MDs, RNs, and EMTs, we developed a training exercise to help improve coordination and decision making in their unit. The exercise consists of two components - a paper-and-pencil triage exercise and an electronic Decision Making Exercise (DMX) - in which staff members are required to make rapid decisions about treatment based upon realistic patient descriptions. The exercise focuses on understanding the roles and functions of emergency department team members, making explicit the expectations of team members on the unit, and learning the standard treatment methods for common cases in the emergency department. The exercise was developed to be low cost, but to have high cognitive authenticity - i.e., evoking the same reasoning and decision-making processes that would be used daily in an actual emergency department.

Initial evaluations with two teams of nurses and physicians at the hospital indicated improvement in the ability to deal with common emergency team problems associated with scope of practice, alignment of expectations, and utilization of resources. With a design capability that allows the trainer to easily modify the patient descriptions and physical layout, this training can be implemented across healthcare facilities, targeting the specific challenges of those facilities.