Priyadarshini R. Pennathur

Technologies in the wild (TiW): human factors implications for patient safety in the cardiovascular operating room

We describe different sources of hazards from cardiovascular operating room (CVOR) technologies, how hazards propagate in the CVOR and their impact on cognitive processes. Previous studies have examined hazards from poor design of a specific CVOR technology. However, the impact of different CVOR technologies functioning in context is not clearly understood. In addition, the impact of non-design hazards in technology devices is unclear. Our study identified hazards from organisational, physical/environmental elements, in addition to design of technology in a CVOR. We used observations, follow-up interviews and photographs. With qualitative analyses, we categorised the different hazard sources and their potential impact on cognitive processes. Patient safety can be built into technologies by incorporating user needs in design, decision-making and implementation of medical technologies. Practitioner summary: Effective design and implementation of technology in a safety-critical system requires prospective understanding of technology-related hazards. Our research fills this gap by studying different technologies in context of a CVOR using observations. Qualitative analyses identified different sources for technology-related hazards besides design, and their impact on cognitive processes.

Assessing the Impact of Computerization on Work Practice: Information Technology in Emergency Departments

Typical hospital emergency departments (ED) use patient status boards as information tracking devices for providing safe care by supporting shared memory, latent processes, collaboration, shared cognition, communication and coordination. Traditionally, status boards are large, manually updated dry erase “whiteboards.” Though electronic patient tracking technologies are fast replacing manual status boards, significant questions remain regarding the design of these technologies and the manner in which they impact ED work. This paper describes part of a study which is documenting the transition from a manual status board to electronic technology in two different emergency departments. The impact of technology implementation on existing work practices, and insights on design of information technology for safety critical healthcare system are described.

Cognitive Artifacts in Transition: An Analysis of Information Content Changes between Manual and Electronic Patient Tracking Systems

Todays emergency departments (ED) could not function without a patient tracking system of some kind, manual or electronic. Manual patient tracking systems such as “whiteboards” are large, dry erase, manually updated status boards used as information tracking devices in most EDs. Although it is expected that manual whiteboard systems will completely transition to electronic patient tracking systems with increasing availability of technological solutions, it is not clear if these technological solutions will sufficiently address the information tracking needs of providers. This study documents the changes in the use of a manual whiteboard versus an electronic patient tracking system in an ED to compare types of information and meanings of the represented information. Results show that both systems were used to represent information serving a variety of functional roles. In addition, an analysis of patient chief complaint entries indicates that manual whiteboards are used more dynamically than electronic systems. Differences in functional uses of the systems and the consequences of these changes are discussed.

Development of a simulation environment to study emergency department information technology

Introduction: This article presents a simulation architecture for a patient tracking system simulator to study caregiver performance in emergency departments (EDs). The architecture integrates discrete event simulation modeling with clinical patient information. Evaluation components for electronic patient tracking system displays are also described. Methods: A simulation of an ED electronic whiteboard was developed to study situation awareness metrics. Dynamic process data from an actual ED was used to generate simulation parameters including patient arrivals at various hours, distribution of severities, times required to treat the ED patients, and ancillary turnaround times (laboratory and radiology). A team of industrial engineers and ED physicians contributed demographic and clinical information for simulator patients. ED simulation parameters were combined with clinical information resulting in an event timeline database. Event timelines were used to populate a front-end patient-tracking system display simulation. Results: The resulting patient-tracking system display simulation consists of underlying software, desktop and large-screen displays, a phone call/pager system, and typical tasks that enhance the realism of the simulation experience. The system can evaluate the impact of display parameters and ED operations on user performance. Conclusions: Modular design of the patient-tracking system display simulation helps adaptation for different studies to support various interface features and interaction types. The methodology described in this work exploits the benefits of discrete event simulation to iteratively design and test technologies such as electronic patient tracking systems and allows assessment of human performance measures.

Handoff Communication: Implications For Design

Handoff communication is one of the most typical clinical communication mechanisms in a healthcare setting to transfer information and responsibilities of the care provider. Handoff communication is varied across settings, provider type, and even within a clinical unit. Information technology has the capability to support handoff communication, with better understanding of handoff communication needs and variations. This panel examines (1) how handoff communication happens in the healthcare setting through mini-cases (2) insights on information technology design for handoff communication.

Usability Evaluation and Implementation of a Health Information Technology Dashboard of Evidence-Based Quality Indicators

Health information technology dashboards that integrate evidence-based quality indicators can efficiently and accurately display patient risk information to promote early intervention and improve overall quality of patient care. We describe the process of developing, evaluating, and implementing a dashboard designed to promote quality care through display of evidence-based quality indicators within an electronic health record. Clinician feedback was sought throughout the process. Usability evaluations were provided by three nurse pairs and one physician from medical-surgical areas. Task completion times, error rates, and ratings of system usability were collected to compare the use of quality indicators displayed on the dashboard to the indicators displayed in a conventional electronic health record across eight experimental scenarios. Participants rated the dashboard as “highly usable” following System Usability Scale (mean, 87.5 [SD, 9.6]) and Poststudy System Usability Questionnaire (mean, 1.7 [SD, 0.5]) criteria. Use of the dashboard led to reduced task completion times and error rates in comparison to the conventional electronic health record for quality indicator–related tasks. Clinician responses to the dashboard display capabilities were positive, and a multifaceted implementation plan has been used. Results suggest application of the dashboard in the care environment may lead to improved patient care.

Healthcare Systems Design At a Crossroads Challenges, Opportunities and Strategies

The healthcare work system contains many constraints resulting from changes in workflow and system structure. The panel reflects on challenges in the healthcare work system human factors researchers can address to improve patient safety. The panelists address: (1) the growing complexities in healthcare and patient safety from the provider and patient perspectives; (2) successful applications of human factors approaches to healthcare systems design; (3) and barriers in following a systems approach and strategies to overcome the challenges that remain for enhancing patient safety.

Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities

Opinion statementHuman factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.

How lapse and slip errors influence head-of-bed angle compliance rates as measured by a portable, wireless data collection system

The recommended protocols to prevent ventilator-associated pneumonia include keeping ventilated patients’ head and upper body elevated to an angle between 30 and 45 degrees. These recommendations are largely based on a study that has been difficult to replicate, because studies that have attempted to replicate the original conditions have failed to achieve the necessary bed angles consistently. This work suggests the possibility that two specific types of human error, slips and lapses, contribute to non-compliant bed angles. A novel device provided 83,655 samples of bed angles over a period of 1579 hours. The bed angle was out of compliance 64.2% of the time analyzed. Slips, the accident of raising the bed to an angle slightly less than the desired angle, accounted for most of the out-of-compliance measurements, or 55.9% of the time analyzed. It appears that stochastic variation in the bed adjustments results in the bed being out of compliance. Interventions should be investigated such as increasing the target angle and providing feedback at the moment the bed is raised to close to, but less than, the target angle.

Following the trail: understanding information flow in the emergency department

Abstract A hospital emergency department (ED) is a complex cognitive work system. ED providers routinely create, process and share various kinds of information in their work. They may constantly transform information using technological artifacts such as an electronic patient information system. The functionality in the technology, however, limits their tasks and activities. So, they create their own artifacts (such as handwritten notes on a post-it note), to share and process information. The goal of the paper is to illustrate how health providers in EDs create, process, transform and share information to achieve work goals. We present the information trail model in the ED to illustrate various facets of information creation activity and generate insights for health information technology design.