Jenna L. Marquard

Eye Tracking as a Debriefing Mechanism in the Simulated Setting Improves Patient Safety Practices

Introduction:Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. Methods:An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. Results:All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking–only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as “Compares patient stated name with name on ID band.” Conclusions:Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

Background:Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. Purpose:The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele–home care. Methodology:A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. Results:The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Clinical Implications:Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Consumer Health Informatics Interventions Must Support User Workflows, Be Easy-To-Use, and Improve Cognition: Applying the SEIPS 2.0 Model to Evaluate Patients’ and Clinicians’ Experiences with the CONDUIT-HID Intervention

ABSTRACT The aim of this research was to gain a holistic understanding of patients’ and clinicians’ experiences with the CONDUIT-HID (CONtrolling Disease Using Inexpensive Technology—Hypertension In Diabetes) intervention, intended to be a technology-enabled consumer health informatics (CHI) approach to control hypertension. We examined patients’ experiences utilizing the technologies to share patient blood pressure data with their care team via a qualitative analysis of patient (n = 21) and clinician (n = 5) interviews. Using the SEIPS 2.0 sociotechnical systems model, our evaluation revealed that minimizing usability issues and supporting participant workflow were important—but not sufficient—for CHI intervention success. The ability of the CHI intervention to support the cognitive development of patients’ self-management skills and to facilitate strategic collaboration among care team members was also important. These insights can provide CHI and the human–computer interaction (HCI) communities with a framework of generalizable findings to better design future CHI interventions.

Eye Tracking: A Novel Approach for Evaluating and Improving the Safety of Healthcare Processes in the Simulated Setting

Introduction Eye tracking, used to evaluate a clinician’s eye movements, is an example of an existing technology being used in novel ways by patient safety researchers in the simulated setting. The use of eye-tracking technology has the potential to augment current teaching, evaluation, and research methods in simulated settings by using this quantitative, objective data to better understand why an individual performed as he or she did on a simulated or naturalistic task. Methods Selected literature was reviewed with the purpose of explicating how eye tracking can be used by researchers and educators to evaluate error-prone processes. The literature reviewed was obtained by querying the databases PubMed, CINHAL, and Google Scholar using the key words eye tracking, patient safety, and medical errors from 2005 through 2015. An introduction to the use of eye tracking, including both theoretical underpinnings and technological considerations, is presented. In addition, examples of how eye tracking has been used in research studies conducted in both simulated and naturalistic settings are provided. Conclusions The use of eye-tracking technology to capture the eye movements of novice and expert clinicians has provided new insight into behaviors associated with the identification of medical errors. The study of novices’ and experts’ eye movements provides data about clinician performance not possible with existing evaluation methods such as direct observation, verbal reports, and thinking out loud. The use of eye tracking to capture the behaviors of experts can lead to the development of training protocols to guide the education of students and novice practitioners. Eye-tracking technology clearly has the potential to transform the way clinical simulation is used to improve patient safety practices.

Development of Regional Health Information Organizations (RHIOs): knowledge networks and collaboration

The development of Regional Health Information Organizations (RHIOs) has become an important priority for policymaking in the USA. These development efforts have focused primarily on data exchange. In this paper, we propose the use of a research approach, based on knowledge networks and collaboration, to develop an understanding of the processes associated with RHIO development. RHIOs need to be envisioned beyond the need to exchange electronic health information exchange and be seen as the catalyst for knowledge sharing of evidence-based medical practices. Sharing evidence-based medical and clinical practices allows for shared system improvement. Networks have been perceived as a foundation for forming inter-organisational collaborations. The term network implies a structure to relate social actors while collaboration is the process whereby social actors in the network take collective actions to achieve a common goal. RHIOs can serve as convener organisations that can act as a catalyst for bringing diverse stakeholders to work together toward a common purpose and a set of goals that benefit the community.

Field-Based Human Factors in Home and Community Settings: Challenges and Strategies

Studies of complex health and healthcare phenomena such as transitions of care, chronic disease management, or care coordination, often require field work spanning people, time, and place. The scope of such field work often includes patients and their families and settings such as the home and community. Human factors researchers are identifying the challenges associated with conducting such work and are developing practical strategies. This panel gathers human factors experts to address the question: What are the challenges to and strategies for conducting human factors field research on health and healthcare with multiple individuals including patients, over longer periods of time, and across settings including the (patient) home and community? Panelists answer this question by describing their personal experiences with multiple studies and provide vignettes for grounding an interactive panelist-audience discussion.

Using an eye tracker during medication administration to identify gaps in nursing students' contextual knowledge: an observational study.

In this clinical simulation study using an eye-tracking device, 40% of senior nursing students administered a contraindicated medication to a patient. Our findings suggest that the participants who did not identify the error did not know that amoxicillin is a type of penicillin. Eye-tracking devices may be valuable for determining whether nursing students are making rule- or knowledge-based errors, a distinction not easily captured via observations and interviews.

The Work and Work Systems of Patients: A New Frontier for Macroergonomics in Health Care

To maintain and improve their health, patients perform many non-paid activities that may be conceptualized as self-care and self-management work. However, within the domain of health care, macroergonomists have almost exclusively focused on analyzing the work and work systems of those employed by the health care system rather than those served by it. This panel will focus on how macroergonomics principles and models originally developed within an institutional context may be adapted for the contexts in which patients are embedded. The discussion will be grounded in specific analyses of patients’ work and work systems within domains such as consumer health information technology design, self-care work performance, transitions of care, and patient safety. During each of these presentations, panelists will focus on lessons related to the conceptual, methodological and practice-related challenges of understanding and affecting patients’ work and work systems that may be applied by other researchers.

Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth

Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of the start of telemonitoring. In adjusted analyses, the patients’ number of medications and type of cardiac medications were significantly (P < 0.05) associated with an increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P < 0.05) predictors associated with an increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, pulmonary and obesity co-morbidities within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The studys findings may assist homecare agencies seeking to allocate resources without compromising patient care.

Can Visualizations Complement Quantitative Process Analysis Measures? A Case Study of Nurses Identifying Patients Before Administering Medications

The objective of this study is to demonstrate the effectiveness of visualizations for exploring one error-prone health care process: nurses verifying patients’ identities during the medication administration process. We employed three types of process visualizations (i.e., Markov chains, sparklines, and timeline belt visualizations) to explore process execution data from an experiment wherein nurse participants (N = 20) administered medications to three patients in a simulated clinical setting. One patient had an embedded error, with the medication being incorrect for the patient. The visualizations allowed us to view aggregate and individual-level process execution data, providing insights into the orders in which participants completed process steps. Although we used eye tracking videos, the system developed in this study can automatically generate visualizations using large process execution data sets produced from an array of sources, including observations, sensors, and health IT audit trails. In this article, we demonstrate that the visualizations provide insights complementary to quantitative measures regarding what process steps participants likely used to identify errors, with the visualizations requiring less work to produce. Therefore, the visualizations may be an effective means for efficiently comparing sets of process execution data (e.g., different individuals completing a process, pre– and post–technology implementation, pre– and post–quality improvement intervention).