Sudeep Hegde

User-Preferred Position of Computer Displays: Effects of Display Size

Objective: Effects of display size and dual display setting on preferred display and keyboard positions were evaluated. Background: User-preferred display position may vary as its size changes or when multiple displays are used. It is also not known whether the use of larger displays or multiple displays would influence positioning of the keyboard. Method: Participants (N = 19) who had normal visual acuity (20/30 or better) determined preferred positions of the display and the keyboard during a data entry task in four display setups (19, 24, 27.5, and dual 19 in.). The size of capital characters (3.2 mm high) was kept consistent between setups. Results: Preferred viewing distance ranged from 0.68 m (19-in. display) to 0.76 m (27.5-in. display). No significant differences in viewing distance and display height were found between the single 19-in. display and dual 19-in. displays setups. The preferred position of the keyboard was consistent between display setups. Conclusion: Participants placed larger displays farther and lower while maintaining the display top at or near eye height. Preferred position of the dual displays in landscape setting did not differ from that of a single display. It appears that the preferred display position varies with the vertical dimension of the overall viewable area of the display. Application: The results of this study can be used to determine the dimensions or adjustability of computer workstations for larger displays or multiple displays settings.

An evidence‐based toolkit for the development of effective and sustainable root cause analysis system safety solutions

Root cause analysis (RCA) after adverse events in healthcare is a standard practice at many institutions. However, healthcare has failed to see a dramatic improvement in patient safety over the last decade. In order to improve the RCA process, this study used systems safety science, which is based partly on human factors engineering principles and has been applied with success in other high-risk industries like aviation. A multi-institutional dataset of 334 RCA cases and 782 solutions was analyzed using qualitative methods. A team of safety science experts developed a model of 13 RCA solutions categories through an iterative process, using semi-structured interview data from 44 frontline staff members from 7 different hospital-based unit types. These categories were placed in a model and toolkit to help guide RCA teams in developing sustainable and effective solutions to prevent future adverse events. This study was limited by its retrospective review of cases and use of interviews rather than clinical observations. In conclusion, systems safety principles were used to develop guidelines for RCA teams to promote systems-level sustainable and effective solutions for adverse events.

Assessment of Innovative Emergency Department Information Displays in a Clinical Simulation Center

The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-physician teams performed simulated emergency department tasks. Questionnaires were used to assess the cognitive support provided by the displays, participants’ level of situation awareness, and participants’ workload during the simulated tasks. Participants rated the new displays significantly higher than the control displays in terms of cognitive support. There was no significant difference in workload scores between the display conditions. There was no main effect of display type on situation awareness, but there was a significant interaction; participants using the new displays showed improved situation awareness from the middle to the end of the session. This study demonstrates that cognitive systems engineering methods can be used to create innovative displays that better support emergency medicine tasks, without increasing workload, compared to more standard displays. These methods provide a means to develop emergency department information systems—and more broadly, health information technology—that better support the cognitive needs of healthcare providers.

Usability evaluation of an emergency department information system prototype designed using cognitive systems engineering techniques

This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the displays ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components. Mean ratings were positive for cognitive performance support objectives, usability, usefulness, and frequency of use, demonstrating the successful application of design methods to create useful and usable EDIS concepts that provide cognitive support for emergency medicine staff. Nurse and provider roles had significantly different perceptions of the usability and usefulness of certain EDIS components, suggesting that they have different information needs while working.

A Bottom-Up Approach to Understanding the Efficacy of Event-Analysis in Healthcare: Paradigm Shift from Safety to Resilience Engineering

Root Cause analysis (RCA) is a widely implemented event-analysis tool in healthcare, used to improve pa-tient safety. Several studies have assessed the effectiveness of RCA solutions and provided recommenda-tions for improving the approach; however few have suggested a systematic approach to align RCA-based interventions with the realities of work practice in healthcare. In this study, semi-structured interviews were conducted with frontline healthcare staff (nurses, nurse managers and technicians) in order to assess their perspectives on the effectiveness and sustainability of RCA-based solutions in a large academic medical center. In general, preventive interventions such as physical environment or equipment changes were more effective and sustainable than reactive or passive measures such as reviews and compliance checks. A the-matic analysis of respondents’ narratives highlighted several issues related to the design and implementa-tion of various RCA-driven interventions. The analysis however, also revealed important facets of frontline medical practice, including the role played by staff in overcoming systemic hazards in order to increase pa-tient safety. These findings are discussed in the context of the emerging Resilience Engineering approach to safety in complex systems.

Supporting The Work of Ed Clinicians Assessment Of A Novel Emergency Department Information System In A Clinical Simulation Center

There has been momentum to quickly develop health information technology (IT), but these developments may not result in the expected benefits if the IT is not designed to support caregivers. This research aimed to create an interface for emergency department tracking and control using cognitive systems engineering methods. Comparison of the novel displays with currently in-use display designs in a clinical simulation center demonstrated that the novel displays better support the work of providers without increasing workload.

Knowledge Elicitation for Resilience Engineering in Health Care

The Critical Incident Technique (CIT) and the Critical Decision Method (CDM) have been employed successfully to elicit information about human activities, explicate expert knowledge and model decision-making in various domains. Because of their proven efficacy in naturalistic settings, we adapted these methods to develop a script for interviews about resilience in health care. The multi-stage, semi-structured format of the CIT and CDM was adopted as a broad template for the script. However, new questions and probe-types for each stage were created which conformed to the theoretical framework of resilience engineering (RE). Hollnagel’s Resilience Analysis Grid (RAG) was used to derive a majority of the probes for each of the capabilities of a resilient organization – monitoring, anticipating, responding and learning. The interview script was iteratively revised based on responses to pilot interviews as well as feedback by human factors and RE experts. The final script was used to successfully interview physician and nurse-providers at various organizational levels and units.

Characterising the effect of interoperability on healthcare work: a novel framework

Successful design and implementation of interoperable health IT requires an understanding of specific technological capabilities of systems, as well as how these systems impact clinical workflow. Several existing frameworks classify interoperability levels, but none focus on the impact on clinical work, particularly at the task level. A synthesis of existing interoperability frameworks from select interoperability frameworks in the literature about both medical and non-medical systems is presented and a new, 7-level framework in order to characterise the effect of varying levels of interoperability on the users’ work based upon qualitative data collected in a field study of the use of health information exchange in 12 ambulatory practices is proposed. The lowest level describes paper-based tasks completed with no access to electronic information from other institutions; the highest level describes interoperable systems in which data elements from other institutions are integrated into the patients record seamlessly and in a computable format.

Towards the Development of a Resilience Engineering Tool to Improve Patient Safety The RETIPS Approach

Over the last few years, patient safety research has seen a paradigm-shift marked by the advent of Resilience Engineering (RE). Findings from the team’s previous research on the efficacy of root-cause analysis in improving patient safety revealed the potential to analyze existing resilient system properties and leverage the same in system-design and improvement. A multi-phase research plan to develop a lessons-learned system for resilience engineering in healthcare is described. The focus of this paper is the first phase, which involved critical-incident interviews to elicit detailed information from frontline health care workers regarding real-life examples of resilience. 14 interviews were conducted with clinicians and nurses from a large, multi-hospital medical system. Multiple examples of resilience and factors pertinent to patient safety were extracted and aligned with system capabilities which are the cornerstones of resilience – learning, responding, anticipating and monitoring. Resilience was also seen to manifest at various levels of the work organization. These results demonstrate the feasibility of using the critical incident interviewing method to analyze resilience in a healthcare organization. The data from the interviews will further be used to develop a Resilience Engineering Tool to Improve Patient Safety (RETIPS) that can be implemented organization-wide for reporting and analysis of resilience-based cases.

User-preferred position of computer displays of different sizes and configurations

User-preferred position of the computer display and the keyboard were quantified to determine how the size and/or the number of computer displays (19″, 24″, 27.5″, and dual 19″ LCDs) influence the positioning of the computer workstation components. Nineteen subjects performed a data entry task for 20 minutes with periodic repositioning of the display and the keyboard to their most comfortable setting. Subjects placed displays significantly (p<0.05) further as the size of display changed from 19″ to 27.5″ while maintaining the viewing angle to the top and center of display at or near eye height. Preferred position of the keyboard was not influenced by the display size. Results of this study indicate that the dimensions or adjustability of a computer workstation should be determined with consideration of the display size to accommodate both the keyboard and the display at their most preferred positions.