Clinical work is accomplished by complex, highly distributed, joint cognitive systems, and involves high levels of uncertain and ambiguity. Hospital emergency departments in particular must adapt to uncertainty, ambiguity, and change on a variety of different time scales. Many of these adaptations are unofficial, in part because they cannot be specified in advance, and in part because the official models of healthcare work do not include them. This paper presents two case studies of adaptation in the ED and uses them to explore implications for cognitive engineering and design.
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