Justin M. DeVoge

Collaborating With Physicians to Redesign a Sign-Out Tool

Physician sign-out is a mechanism for transferring patient information from one group of hospital care-givers to another at shift changes. Support tools are critical to the success of sign-out. To ensure that a tool is effective, designers must collaborate with end users, but collaboration can be difficult when working with users who are busy and have irregular schedules. In this article, we report on a collaborative effort between physicians and engineers to redesign a sign-out support tool. Strategies included focus groups, interviews, “on-the-fly” feedback, and an iterative design process, which engaged end users in the design process. Task analysis methods enabled us to quantify the differences in functionality between the original tool and the prototype.

Resident physicians as human information systems: sources yet seekers.

Objective To characterize question types that residents received on overnight shifts and what information sources were used to answer them. Materials and Methods Across 30 overnight shifts, questions asked of on-call senior residents, question askers’ roles, and residents’ responses were documented. External sources were noted. Results 158 of 397 questions (39.8%) related to the plan of care, 53 (13.4%) to medical knowledge, 48 (12.1%) to taskwork knowledge, and 44 (11.1%) to the current condition of patients. For 351 (88.4%) questions residents provided specific, direct answers or visited the patient. For 16 of these, residents modeled or completed the task. For 216 questions, residents used previous knowledge or their own clinical judgment. Residents solicited external information sources for 118 questions and only a single source for 77 (65.3%) of them. For the 118, most questions concerned either the plan of care or the patients current condition and were asked by interns and nurses (those with direct patient care responsibilities). Discussion Resident physicians serve as an information system and they often specifically answer the question using previous knowledge or their own clinical judgment, suggesting that askers are contacting an appropriately knowledgeable person. However, they do need to access patient information such as the plan of care. They also serve an educator role and answer many knowledge-related questions. Conclusions As synchronous verbal communications continue to be important pathways for information flow, informaticians need to consider the relationship between such communications and workflow in the development of healthcare support tools.

A Web architecture to support the tailoring of training content and learner assessment

Instructional systems designers can face a difficult task with training development including curriculum content delivery method, and learner assessment. This situation becomes more complex when multiple types of learners must be trained with overlapping but not completely similar content. This paper discusses a flexible Web-based architecture that supports the tailoring of training content and learner assessment. The architecture supports the creation of multiple training treatments and assessments, and learner performance data collection.

Content development for a Web-based system devoted to flight dispatcher icing training

In the airline industry, flight dispatchers are responsible for planning aircraft routes safely and economically. Training is essential to help dispatchers understand when and where icing may occur and what to do when it does. The goal of this project was to develop content for a Web-based system devoted to flight dispatcher icing training. The content addresses basic meteorology and weather product interpretation so that flight dispatchers can learn how to determine where icing is and might form. It also includes scenarios to support the flight dispatcher decision making process. To develop the content, we collaborated with a regional airline and a major domestic airline. This paper describes the progress to date on the content development effort. For each content area, the lesson objectives and topic content are described. The paper also discusses the remaining effort required to complete the content development process

Design of an Instructional System for Flight Dispatcher Icing Training

Atmospheric icing plays a critical role in the daily responsibilities and decision making of airline flight dispatchers. To maintain safety, airlines must be sure that dispatchers are trained to a deep understanding of this topic. It is difficult, however, for current training programs to review icing to the depth that is necessary. In addition, systematically designed training products focusing on atmospheric icing do not exist for flight dispatchers. Flight dispatchers and instructors express the need for systematically designed icing training products standardized for flight dispatchers. The field of instructional systems design (ISD) offers methods for the creation of such products. In recognition of the need for flight dispatcher centered training products, this paper discusses the development of a preliminary icing training system for flight dispatchers, framed within a modern ISD model. It focuses on the higher and lower level instructional goals, the content to achieve these goals, and the evaluation materials and strategy to assess the training system.

Characterization of Pediatric Resident Handover at Change of Shift to Inform Process Improvement

Incomplete and/or unclear transfer of patient information can adversely affect the quality of patient care. This study investigated what/how information is exchanged between resident physicians at shift change. 15 sign-outs consisting of 209 patients were observed. Ten categories of patient information, four types of communication, and three sources of distraction were developed to characterize sign-out. The average sign-out lasted 34.4 minutes (standard deviation of 15.9) with 13.9 patients (standard deviation of 3.5) discussed. 23.2% of the time did not focus on patient care. When discussing patient care, 87.2% included one-way information transfer from the resident going off call. 32.2% of the information consisted of prior patient background. 12.1% was spent discussing what actions should/may occur overnight. Residents discussed the current physical condition for 35.4% of the patients, current medications for 62.7%, and contingency plans for 17.7% of patients. Potential improvements should focus on training residents on how to conduct handovers.Incomplete and/or unclear transfer of patient information can adversely affect the quality of patient care. This study investigated what/how information is exchanged between resident physicians at shift change. 15 sign-outs consisting of 209 patients were observed. Ten categories of patient information, four types of communication, and three sources of distraction were developed to characterize sign-out. The average sign-out lasted 34.4 minutes (standard deviation of 15.9) with 13.9 patients (standard deviation of 3.5) discussed. 23.2% of the time did not focus on patient care. When discussing patient care, 87.2% included one-way information transfer from the resident going off call. 32.2% of the information consisted of prior patient background. 12.1% was spent discussing what actions should/may occur overnight. Residents discussed the current physical condition for 35.4% of the patients, current medications for 62.7%, and contingency plans for 17.7% of patients. Potential improvements should focus on training residents on how to conduct handovers.

A Web Architecture to Support Collaborative Training Content Development and Evaluation

Development of web-based training tools requires the collaboration of instructional system designers, domain subject matter experts, web developers, and software engineers. This paper discusses the enhancements to a web-based training architecture to enable collaboration among these contributors. The enhancements allow domain subject matter experts to view the training material and to provide feedback. The paper provides an illustrative example where the system was used during the development of a web-based training tool for flight dispatchers.