Empirical Studies of Complex Decision-Making and Action by Anesthetists

Traditional concepts of decision-making in medicine have concentrated on relatively static, well-structured decisions. For example, should patient A with an elevated blood pressure be treated for hypertension with drug X, or should no treatment be started?^[251] Other investigators have looked only at "diagnosis" as an isolated task (specifically "diagnostic explanation") both in internal medicine^{[252] [253] [254]} and in radiology.^[255] These approaches to decision-making have not captured the unique aspects of dynamism, time pressure, and uncertainty seen in anesthesiology. Over the past decade, a paradigm has emerged concerning decision-making and action in complex real-world situations. ^{[35] [60] [61] [82] [83] [84] [85] [86] [96] [116]} The cognitive model of dynamic decision-making was described previously. Several teams both from inside the anesthesiology profession and from the human performance community have been striving to develop a more comprehensive understanding of the complex performance of anesthetists. Their work has been based on a small number of new experiments (often involving medium- or high-fidelity anesthesia simulators), the reinterpretation of previous experiments, direct and indirect observation of the conduct of anesthesia, and extrapolations from other industries to anesthesiology. Each experiment has probed several aspects of decision-making and action which are described in the following section.