Whiteboard icons to support the blood-test process in an emergency department: an observational study of temporal patterns.

The competent treatment of emergency department (ED) patients requires an effective and efficient process for handling laboratory tests such as blood tests. This study investigates how ED clinicians go about the process, from ordering blood tests to acknowledging their results and, specifically, assesses the use of whiteboard icons to support this process. On the basis of observation and interviews we find that the blood-test process is intertwined with multiple other temporal patterns in ED work. The whiteboard icons, which indicate four temporally distinct steps in the blood-test process, support the nurses in maintaining the flow of patients through the ED and the physicians in assessing test results at timeouts. The main results of this study are, however, that the blood-test process is temporally and collaboratively complex, that the whiteboard icons pass by most of this complexity, that attending to the icons is yet another temporally sensitive activity to remember, and that whereas the assessment of test results is integral to patient treatment, the acknowledgement of having seen the results is a formal add-on, the responsibility for which is sometimes unclear.