Research at ASU to seek ways of reducing preventable medical errors that are factors in the causes tens of thousands of deaths each year in the United States will get support from a grant of almost $5 million from the James S. McDonnell Foundation.

A research team led by Vimla L. Patel, professor and vice chair of the Department of Biomedical Informatics in the university's Ira A. Fulton School of Engineering, will study the processes underlying critical care decision-making to identify weaknesses in such systems and how they can be corrected.

ASU's partners in the project that will share more than $4.7 million over five years from the McDonnell Foundation are researchers at Banner Health System, the University of Texas-Houston and Washington University in St. Louis.

A 1999 Institute of Medicine report suggested between 44,000 and 98,000 people die from medical errors each year in the United States. That is more deaths annually than those attributed to breast cancer, human immunodeficiency virus (HIV) or motor vehicle accidents.

Previous research confirms that the complexity of health care delivery systems are often the primary barrier to implementing more effective measures to ensure patient safety, especially in intensive care units and surgery departments, Patel says.

Studies show the root of the problem is generally not inadequate performance by individual health care professionals, Patel explains.

It is more often factors inherent in the traditional medical culture - the conventional health care management and decision-making processes in complex health care systems, she says.

"The project addresses how humans think and solve problems in a medical context," says McDonnell Foundation president John Bruer.

Medical error "is a very significant social problem that requires more basic cognitive science research if we are going to solve it," Bruer says.

The foundation, founded in 1950 by aerospace pioneer James S. McDonnell, was established to "improve the quality of life." It contributes to the quest for new knowledge through funding for research and scholarship programs. It currently gives about $25 million each year to support neuroscience, psychology and complex systems research, Bruer says.

The ASU project it is supporting will bring together experts in the sciences of cognition and complex systems, biomedical informaticians, simulation experts and critical care clinicians. Their goals is to produce model systems for improving error detection and correction in emergency medicine and intensive care environments.

"The behavior of the system as a whole is considerably more complex than that of any of its parts," Patel says. "Thought processes underlying critical care are distributed across the minds of many types of clinicians and health care providers, as well as physical objects such as notes and computer equipment. The notion of distributed cognition shifts the focus of cognitive science from the study of individuals in controlled settings to the study of groups of individuals in their real-world context."

Over the course of the project, the research partners will hold a conference annually to explore applications of their work with other science and health care groups. Those are to include the Northwestern Institute on Complex Systems at Northwestern University, the Complexity in Social Science project based in France, and the Toronto, Canada-based Cochran Foundation.

Private-sector companies who will collaborate with the project include: Immersion Inc., a leader in medical and surgical simulation; Visicu Inc., a leading health care solutions company; and Intermec Inc., a leader in medical information systems and technologies.

Patel, who came to ASU earlier this year from Columbia University in New York, says she had been thinking about the ideas behind the project for the past several years. "But after coming to Arizona, I made it my priority to develop the ideas further and assemble a collaborative team of researchers," she says. "So I am thrilled that the James S. McDonnell Foundation and its board of directors are as excited about this as I am."

Principal members of Patel's team are:

- Trevor Cohen and Kanav Kahol, both assistant professors of biomedical informatics at ASU
- Jiajie Zhang, a professor at School of Health Information Sciences at the University of Texas-Houston
- Timothy G. Buchman, Edison professor of surgery and professor of anesthesiology and medicine at the University of Washington in St. Louis

From Banner Health System:

- John J. Ferrara, program director for the Phoenix Integrated Surgical Residency and director of the Level I Trauma Center for Banner Good Samaritan Medical Center
- Marshall Smith, clinical director of the Banner Simulation Education and Training Center, and counsel for the Banner Health System for simulation and telemedicine
- Robert H. Groves, medical director for Critical Care-Banner Health, and medical director of Intensive Care, e -ICU.

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