Mapping the territory of renal care: a formative analysis of the cognitive work involved in managing acute kidney injury.

The design and evaluation of healthcare work systems requires an understanding of the cognitive work involved in healthcare tasks. Previous studies suggest that a formative approach would be particularly useful to examine healthcare activities for this purpose. In the present study, methods from cognitive work analysis and cognitive task analysis are combined in a formative examination of managing acute kidney injury, an activity that occurs across primary and secondary healthcare settings. The analyses are informed by interviews with healthcare practitioners and a review of practice guidelines. The findings highlight ways in which the task setting influenced practitioners' activity, and ways in which practitioners approached the activity (for example, how they used data to make decisions). The approach taken provided a rich understanding of the cognitive work involved, as well as generating suggestions for the design of work systems to support the clinical task. Practitioner summary: Healthcare tasks often require decision-making in complex and dynamic circumstances, potentially involving collaboration across different practitioner roles and locations. We demonstrate the use of a formative analysis to understand the cognitive work in managing a clinical syndrome across primary and secondary care settings, and consider the implications for work design.