A scoping review of distributed cognition in acute care clinical decision-making

Eric Wilson, Michelle Daniel*, Aditi Rao, Dario Torre, Steven Durning, Clare Anderson, Nicole H. Goldhaber, Whitney Townsend, Colleen M. Seifert

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Objectives: In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the investigation of decision-making and error. Content: This scoping review maps the evidence collected in empiric studies applying DCog to clinical decision-making in acute care settings and identifies gaps in the existing literature. Summary and outlook: Thirty-seven articles were included. The majority (n=30) used qualitative methods (observations, interviews, artifact analysis) to examine the work of physicians (n=28), nurses (n=27), residents (n=16), and advanced practice providers (n=12) in intensive care units (n=18), operating rooms (n=7), inpatient units (n=7) and emergency departments (n=5). Information flow (n=30) and task coordination (n=30) were the most frequently investigated elements of DCog. Provider-artifact (n=35) and provider-provider (n=30) interactions were most explored. Electronic (n=18) and paper (n=15) medical records were frequently described artifacts. Seven prominent themes were identified. DCog is an underutilized framework for examining how information is obtained, represented, and transmitted through complex clinical systems. DCog offers mechanisms for exploring how technologies, like EMRs, and workspaces can help or hinder clinical decision-making.

Original languageEnglish
Pages (from-to)68-88
Number of pages21
Issue number2
StatePublished - 1 May 2023
Externally publishedYes


  • acute care settings
  • clinical-decision making
  • distributed cognition
  • scoping review
  • systems-level error


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