Meghan Dierks

Sonographic prediction of viability in testicular torsion: preliminary observations.

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele. These findings were correlated with the viability of the testis at surgery. All nine patients with normal homogeneous testicular echogenicity had viable testes at surgery. All seven patients with hypoechoic or inhomogeneous testes had nonviable testes at surgery and pathologic evidence of necrosis. The other findings were less helpful in predicting viability. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis.

Using field observations as a tool for discovery: analys ing cognitive and collaborative demands in the operating room

Field observation studies can be an important tool during the discovery phase of the scientific process. They enable observers to identify and document patterns of interaction among practitioners, complications that arise and adaptive strategies developed in response to the exigencies of the work environment. We conducted an observational study that examined operating room (OR) team performance during ten lengthy and complex surgical procedures. The study allowed us to identify latent factors that complicate the cognitive and collaborative performance of OR teams and can contribute to adverse events, and the strategies that medical practitioners have developed to coordinate performance and to minimis e the potential for adverse events. The paper describes the methodology employed, presents illustrative results and discusses issues unique to the design and analysis of observational studies. While video recordings were not used in this study, the data analysis method and results are illustrative of exploratory data analysis approaches that lend themselves to video analysis.

Organization and Representation of Patient Safety Data: Current Status and Issues around Generalizability and Scalability

Recent reports have identified medical errors as a significant cause of morbidity and mortality among patients. A variety of approaches have been implemented to identify errors and their causes. These approaches include retrospective reporting and investigation of errors and adverse events and prospective analyses for identifying hazardous situations. The above approaches, along with other sources, contribute to data that are used to analyze patient safety risks. A variety of data structures and terminologies have been created to represent the information contained in these sources of patient safety data. Whereas many representations may be well suited to the particular safety application for which they were developed, such application-specific and often organization-specific representations limit the sharability of patient safety data. The result is that aggregation and comparison of safety data across organizations, practice domains, and applications is difficult at best. A common reference data model and a broadly applicable terminology for patient safety data are needed to aggregate safety data at the regional and national level and conduct large-scale studies of patient safety risks and interventions.

Healthcare safety: the impact of Disabling "safety" protocols

With increasing attention to patient safety, hospitals and other clinical facilities are developing practice guidelines and protocols with the specific intent of reducing harm to patients. However, the introduction of these protocols can have unanticipated negative consequences and if followed rigidly can become disabling. We use the manual count procedure that was designed to improve patient safety by reducing the likelihood of leaving an object (e.g., needle, sponge, or instrument) inside a patient body cavity during a surgical procedure to illustrate this point. Using results from a focus group of seven operating room nurses and an observational study of nine complex operations, we show that the count protocol has unanticipated negative consequences that need to be considered in evaluating the net positive gain in patient safety. The study highlights the importance of evaluating the overall impact of proposed protocols in assessing its potential benefits to patient safety.

On process mining in health care

With the increasing demand for health care, hospitals are looking for ways to optimize their care processes in order to increase efficiency, while guaranteeing the quality of the care. Process modeling is a crucial step for process improvement, since it provides a process model that can be analyzed and optimized. Process mining is a recent promising methodology to discover process models based on data from event logs. However, early applications of process mining to health care has produced overly complex models, which have been attributed to the complexity of the health care domain. In this paper, we argue that existing process mining methods fail to identify good process models, even for well-defined clinical processes. We identify a number of reasons for this shortcoming and discuss a few directions for extending process mining methods in order to make them more suitable for the clinical domain.

Applying System Engineering to Pharmaceutical Safety

While engineering techniques are used in the development of medical devices and have been applied to individual healthcare processes, such as the use of checklists in surgery and ICUs, the application of system engineering techniques to larger healthcare systems is less common. System safety is the part of system engineering that uses modeling and analysis to identify hazards and to design the system to eliminate or control them. In this paper, we demonstrate how to apply a new, safety engineering static and dynamic modeling and analysis approach to healthcare systems. Pharmaceutical safety is used as the example in the paper, but the same approach is potentially applicable to other complex healthcare systems. System engineering techniques can be used in re-engineering the system as a whole to achieve the system goals, including both enhancing the safety of current drugs while, at the same time, encouraging the development of new drugs.

Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases.

BACKGROUND Underreporting of surgical adverse events limits the ability to identify quality and safety issues. Automated screening of the clinical information system (CIS) can improve case capture and reduce dependency on self-reporting. We compared screening of a CIS to self-reporting for identifying unplanned reoperation and also examined the relationship between causality and probability of reporting. METHODS Between 2005 and 2009, all unplanned reoperations identified by automated screening of databases were reviewed and classified according to causality. Comparison was made to cases self-reported to departmental morbidity and mortality; conditional probability analysis assessed the likelihood of reporting as a function of causality. RESULTS Of 104,938 operations performed, automated CIS screening identified 1,010 cases requiring unplanned reoperation; 23.6% were self-reported to morbidity and mortality; the probability of reporting varied widely depending on causality. CONCLUSIONS Screening of a CIS for adverse events requiring reoperation revealed significant underreporting, with additional bias in reporting based on underlying causality.

Healthcare Safety: The Impact of Disabling ‘Safety’ Protocols

With increasing attention to patient safety, hospitals and other clinical facilities are developing practice guidelines and protocols with the specific intent of reducing harm to patients. However, the introduction of these protocols can have unanticipated negative consequences and if followed rigidly can become ‘disabling’. We use the manual count procedure that was designed to improve patient safety by reducing the likelihood of leaving an object (e.g., needle, sponge or instrument) inside a patient body cavity during a surgical procedure to illustrate this point. Using results from an observational study of nine complex operations we show that the count protocol can have unanticipated negative consequences that need to be considered in evaluating the net positive gain in patient safety. The study highlights the importance of evaluating the overall impact of proposed protocols when assessing their potential benefits to patient safety.

Learning about Healthcare: Preparing Human Factors Professionals for a Career in Healthcare:

Formally trained human factors professionals are in increasing demand from medical device companies, health care systems, and electronic health record (EHR) vendors to ensure successful device design, EHR deployment, and overall usability and quality improvement initiatives. Most members of this panel have extensive experience working in the healthcare domain, while one is starting a career in healthcare. The panelists will exchange their views on the challenges and rewards of learning about healthcare in order to be effective in making contributions to health care. Specific initiatives human factors professionals can take to learn about healthcare will be introduced and discussed. Human factors professionals and students should expect steep a learning curve, as well as strong support from clinicians and other health care workers, which will be discussed.

Mobile Technology The Wave of the Future to Improve Healthcare

Mobile devices (e.g., smartphones, personal digital assistants, and tablets) are evolving rapidly and growing exponentially in multiple facets around the globe. Specifically, mobile devices can be used as audio and video chat, reference guide, training tool, handoff facilitation, and decision support. Undoubtedly, there are clear advantages of leveraging this technology including automatic updates, portable and unobtrusive access to data, and time savings for documentation allowing clinicians more time for patient care. However, innovative technology brings new yet critical obstacles to overcome (e.g., usability and security). Thus, the current panel is designed to gather leading human factors and medical experts in the fields of clinical care, system design, and human-system interaction to provide their insight and perspective on the following question: What contributions can human factors science and medical experts combine to bring to bear on the development, implementation, and evaluation of mobile-based technology?