This is an exploratory, qualitative research protocol. The immediate goal of the study is to identify principles and guidelines that will serve as a foundation for development of an electronic alternative to the PCCAT and overcomes the limitations of the current paper system. Future studies will refine the principles and guidelines derived from this protocol, allowing customization of an electronic summary based upon clinical experience, domain knowledge, competency, and user preference. The long-term goal is to provide an electronic clinical summary that meets the real-time data and information needs of the individual nurse and can be carried in the pocket of a lab coat.

Cognitive artifacts are external data displays that augment and influence human reasoning, understanding, and decision making. The PCCAT is developed through transcription of data from a variety of resources, serving clinical nurses as a reference in communication of clinical data with and between other healthcare professionals. While the PCCAT supports practice, it also poses risks to patient safety. As a handwritten document with no interfaces or electronic links to data, patient safety is threatened through potential data transcription errors, and by failing to record data key to clinical decisions. This risk is compounded throughout the shift as new data is added or, conversely, not added.

Cognitive artifacts support human cognition through representation of data, and serve as an adjunct to working memory. Patient care in an acute-care, academic hospital setting takes place in a highly interruptive environment. Interruption has been studied by several investigators and demonstrated to contribute to error. Second the capacity limitations of working memory place a premium on supports to working memory. Thirdly, appropriate data display can facilitate the development of insights and understanding, consequently influencing decision making.

Information visualization affords the use of image and graphic formats to display data. An effective information display medium conveys meaning that otherwise may not be apparent to the user. Large, complex, high volume, and/or time-dependent data sets may be more efficiently assimilated through image or graphic techniques, and abstractions may be recognized or become more apparent through the use of effective information visualization formats. Information visualization may also serve as an extension of working memory by aiding thinking and triggering analysis and insight that otherwise may not have been discerned.