Alison G. Vredenburgh

Quantitative description of the workload associated with airway management procedures

STUDY OBJECTIVESnTo measure the workload associated with specific airway management tasks.nnnSETTING AND INTERVENTIONnWritten survey instrument.nnnPATIENTSn166 Stanford University and 75 University of California, San Diego, anesthesia providers.nnnMEASUREMENTS AND MAIN RESULTSnSubjects were asked to use a seven-point Likert-type scale to rate the level of perceived workload associated with different airway management tasks with respect to the physical effort, mental effort, and psychological stress they require to perform in the typical clinical setting. The 126 subjects completing questionnaires (overall 52% response rate) consisted of 43% faculty, 26% residents, 23% community practitioners, and 8% certified registered nurse-anesthetists (CRNAs). Faculty physicians generally scored lower workload measures than residents, whereas community practitioners had the highest workload scores. Overall, workload ratings were lowest for laryngeal mask airway (LMA) insertion and highest for awake fiberoptic intubation. Airway procedures performed on sleeping patients received lower workload ratings than comparable procedures performed on awake patients. Direct visualization procedures received lower workload ratings than fiberoptically guided procedures.nnnCONCLUSIONSnThese kinds of data may permit more objective consideration of the nonmonetary costs of technical anesthesia procedures. The potential clinical benefits of the use of more complex airway management techniques may be partially offset by the impact of increased workload on other clinical demands.

Developing a Technique to Measure Anesthesiologists' Real-Time Workload

Workload is a construct used to describe the extent to which an operator has engaged the cognitive and physical resources required for task performance. As task difficulty increases, operators allocate more resources to maintain acceptable performance. The purpose of the present study is to develop a technique to measure workload continuously, with high-resolution in real-time, and in a way that accounts for the contribution of multiple individual task components of the job of administering anesthesia. Workload associated with 51 clinical tasks performed by anesthesiologists was assessed using a written survey instrument, developed for this study. Participants were 241 anesthesia providers. Interval scale values were computed for each of the tasks using direct estimatation procedures. These values were then used to produce workload density maps for actual anesthesia cases by weighting the tasks performed during the case by their workload scale values. Moment-by-moment data on the specific tasks performed by anesthesiologists were obtained in real-time by trained observers during actual anesthetic cases. This type of analysis can be used to evaluate the costs associated with technical anesthesia procedures, increase our understanding of the anesthesiologists job, and guide rational optimization of procedures, equipment, scheduling, and training.

Communication of Drug Hazard Information: A Critical Analysis of the Relationship between the Pharmaceutical Industry, FDA, Clinicians, and Patients and the Impact on Patient Safety

Adverse drug events (ADE) are common, costly, and responsible for significant morbidity and mortality among hospitalized patients. They are a leading cause of death, accounting for up to 106,000 American deaths annually. Our healthcare system relies on accurate reporting of ADE by clinicians to the pharmaceutical companies, and by the companies to the FDA. The system also relies on the pharmaceutical companies providing accurate and complete warnings and contraindications to physicians and patients. Frequently, however, these risks are not effectively communicated to those who prescribe and take the medications. A critical evaluation of the American drug hazard management system reveals several factors that contribute to these shortcomings and therefore impact patient safety. These system components interact to increase the probability of adverse drug events and accordingly, impact consumer safety.

Designing for Children: What Do Human Factors Professionals Need to Know?

Human Factors and Ergonomics (HF/E) research, projects, expert witness cases, and product designs that target children and their caretakers require a unique set of knowledge and skills. Panelists will describe some of their professional child-focused practices and explain how their education and experiential backgrounds prepared them for this work. In cases where traditional HF/E training was not sufficient, panelists will describe how they met this challenge. The discussion between panelists and attendees will focus on suggestions for preparing HF/E professionals for working with this target market.

Child injury forensic human factors points to the need for better product designs and warnings

A set of cases concerning child injury is described in which there are several human factors/ergonomics (HFE) issues. Each panelist describes an injury or death of a child with a brief overview of the events that occurred. Major HFE issues are presented and discussed using the framework of the hazard-control hierarchy of designing out, guarding against, and warning about hazards. Consideration is not only given to children but also caretakers in the design of useable and safe products. A secondary purpose of the panel is to discuss interest in forming a special interest or technical group on children’s HFE issues.

Amusement Park Guest Injured on a Water Ride: A human factors and biomechanics evaluation

When human factors and biomechanics professionals are retained to evaluate injury accidents, environmental design, hazard management and other relevant issues must be considered to develop opinions. This case study evaluates a forensic human factors and biomechanics case where a woman alleged that a water ride at an amusement park shot pressurized water into her ear, resulting in injuries. When evaluating the case, water droplet data was collected and relevant communication and system design factors were considered, along with the plaintiff’s personal knowledge and habits. This case illustrates when interactive environmental features result in a failure to warn and injuries.

Forensic Case Study: When labeling leads to wrongful incarceration

This case study involves a woman who travelled to Mexico and returned to the United States transporting bottles of cuajo, a substance derived from a calf’s stomach, which is used to make cheese. She informed the border officer that the liquid in the bottle was used to make cheese and she had receipts in her possession for purchasing cuajo. A Safariland NarcoPouch field drug kit was used to test the liquid, which produces an expected color change to any substance that contains secondary amines, including methamphetamine and MDMA. A positive test result to the cuajo when tested at the Port of Entry was a major factor in deciding to arrest the woman, who was held in jail for more than six months; the results of gas chromatograph/mass spectrometer testing indicated that there was no controlled substance in the bottles and she was released. The human factors issues for this matter include adequacy of training, instructions and warnings which misled officers to believe that the test was conclusive for methamphetamine, resulting in her lengthy incarceration.

Adult Products That Kill and Injure Children

Many of the most dangerous products killing and injuring children are not toys – they are adult products. Of the 150,000 products regulated by the CPSC, ATVs are responsible for more child deaths annually than any other. In many cases, the children injured or killed were riding adult ATVs. Products inside the home are also responsible for deaths and serious injuries. Dressers and televisions tip over and kill children at a rate of one every two weeks. Window covering cords have strangled at least one child every month for decades. And button batteries found in everything from remote control devices to bathroom scales are ingested by infants and young children, causing serious injuries and death. Finally, cell phone use by children has opened up a wide range of serious risks - not only driving and pedestrian accidents, but also risks associated with exposure to strangers and unsafe products. In this alternative format panel, experts address each of these products and explore how risk perception – by parents and children – affects their behavior and exposure to the hazard. Limitations of voluntary and mandatory regulations to mitigate product hazards are also discussed.

Types of Consumer Products

This chapter defines and describes which consumer factors, such as age, education and status, impact purchase decisions and explores several categories of consumer products. Consumers’ purchasing considerations differ depending on how much thoughtfulness plays a role in decision-making. Some consumer products require analysis and comparison prior to making a purchase decision. Not all consumer products are desired; some are purchased out of immediate need. Unsought and emergency products are purchased in response to unexpected stimuli and experiences. Unlike other consumer products, digital goods have nearly infinite supply, as the costs to download and distribute a digital song, for example, is negligible. Services, such as insurance, medical care or house cleaning are not something you can hold or that can be physically broken; thus they share a similar intangible as digital goods. Differences between industrial, consumer, do-it-yourself and self-service products are discussed. Thus, there is a diverse selection of consumer products available to a wide variety of consumers that are defined and explored.

Risk Communication for Consumer Products

There are many ways that product manufacturers can communicate risk to consumers. The hazard control hierarchy describes the fundamental elements and appropriate methodology for implementation of research-supported concepts and provides effective techniques for risk communication. Distinctions among types of risk communication and relevant standards are reviewed. Comprehension of risk information by product users is an essential part of the communication process. Label conspicuity and placement on the product are considered as to how they impact the efficacy of a warning, and are evaluated in real-world applications. Anti-warnings: communications that downplay risks and/or undermine warnings are also important to consider and are discussed relative to their effect on warning communications.