Complex Spaces in Emergency Medicine

Complex Case Review

Prior to Covid-19, we asked our partners at Brown what a useful first project could be to improve decision-making in the ER. Planning and conversation were evolving towards re-examining specific medical cases through a design process and systems lens. However, Covid-19 has changed the landscape drastically, requiring us to pivot and rethink what an initial project should be:

In its originally conceived form:

Phase I of Complex Spaces has a dual focus, to help clinical staff:

  1. reflect on how they could ask better questions to approach decision-making as wholes, and;
  2. develop mindsets and practices that could be applied immediately to improve outcomes and care delivery.

Over 90-120 minute sessions, faculty and students from Alpert Medical School, Brown University, and RISD will come together to examine how clinical decisions are made in the ER with the goal of surfacing questions that need to be addressed that are not traditionally asked. Contributions from other practitioners of care delivery will be encouraged and welcome, including nursing and pharmacy professionals, social workers, case managers, and hospital administrators. Each session will set the learning conditions necessary to level authority and expertise.

The aim of each session will be to explore boundaries we believe to be fixed, which may prevent clinical staff from considering a broader set of questions to improve decision-making. Issues will be probed from multiple dimensions and scales, bringing together different perspectives and inputs. As a set, the sessions will use a design process to analyze situations as wholes, overriding the tendency to compartmentalize or limit how situations are understood. This means unpacking important process questions, including but not limited to facts, mental models, behaviors, and teamwork, along with the social and environmental conditions which shape outcomes. The sessions will work to equip front-line clinical staff to better engage the systemic nature of cases which lie beyond any single expertise. Participants will question how all the relevant factors behind difficult situations in ER should be considered together, re-examining unquestioned assumptions, beliefs, and norms common to clinical decisions.