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Butler MJ, Arneil C, Whitelaw AS, Thomson K, Gordon MWG, Thorburn J, Shiels D, Lowe DJ. Implementation of major trauma app: usability and data completeness. BMC Emerg Med 2024; 24:136. [PMID: 39075337 PMCID: PMC11288075 DOI: 10.1186/s12873-024-01022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 06/12/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The current UK standard for major trauma patients is to record notes in a paper trauma booklet. Through an innovative collaboration between a major trauma centre and a digital transformation industry partner, a TraumaApp was developed. Electronic notes have been shown to have fewer errors, granular data collection and enable time stamped contemporaneous record keeping. Implementation of digital clinical records presents a challenge within the context of trauma multidisciplinary trauma resuscitation. Data can be easily accessible and shared for quality improvement, audit and research purposes. This study compared paper and electronic notes for completeness and for acceptability data following the implementation of the TraumaApp. METHODS Trauma team members who performed scribe function attended training for the newly launched TraumaApp. Two staff members acted as scribe, using either the paper trauma booklet or TraumaApp, and attended major trauma calls. A framework for comparison of paper and electronic notes was created and used for a retrospective review of major trauma patients' notes. Statistical analysis was performed using a two-tailed t-test. Staff using the TraumaApp completed a System Usability Score questionnaire. RESULTS There was a total of 37 data points for collection per case. The mean numbers collected were paper notes 24.1 of 37 (65.1%) and electronic notes, 25.7 of 37 (69.5%). There was no statistical significance between the completeness of paper and electronic notes. The mean System Usability Score was 68.4. DISCUSSION Recording accurate patient information during a major trauma call can be challenging and the role of the scribe to accurately record events is critical for immediate and future care. There was no statistically significant difference in completeness of paper and electronic notes, however the mean System Usability Score was 68.4, which is greater than the internationally validated standard of acceptable usability. CONCLUSION It is feasible to introduce digital data collection tools enabling accurate record keeping during trauma resuscitation and improve information sharing between clinicians.
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Affiliation(s)
- Miss Joanna Butler
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
- Clyde Trauma and Orthopaedics, Royal Alexandra Hospital, Paisley, PA2 9PN, UK
| | - Clare Arneil
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Alan S Whitelaw
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Kevin Thomson
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Malcolm W G Gordon
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Josh Thorburn
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Darren Shiels
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - David J Lowe
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK.
- School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.
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Te R, Zhu B, Ma H, Zhang X, Chen S, Huang Y, Qi G. Machine learning approach for predicting post-intubation hemodynamic instability (PIHI) index values: towards enhanced perioperative anesthesia quality and safety. BMC Anesthesiol 2024; 24:136. [PMID: 38594630 PMCID: PMC11003123 DOI: 10.1186/s12871-024-02523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Adequate preoperative evaluation of the post-intubation hemodynamic instability (PIHI) is crucial for accurate risk assessment and efficient anesthesia management. However, the incorporation of this evaluation within a predictive framework have been insufficiently addressed and executed. This study aims to developed a machine learning approach for preoperatively and precisely predicting the PIHI index values. METHODS In this retrospective study, the valid features were collected from 23,305 adult surgical patients at Peking Union Medical College Hospital between 2012 and 2020. Three hemodynamic response sequences including systolic pressure, diastolic pressure and heart rate, were utilized to design the post-intubation hemodynamic instability (PIHI) index by computing the integrated coefficient of variation (ICV) values. Different types of machine learning models were constructed to predict the ICV values, leveraging preoperative patient information and initiatory drug infusion. The models were trained and cross-validated based on balanced data using the SMOTETomek technique, and their performance was evaluated according to the mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE) and R-squared index (R2). RESULTS The ICV values were proved to be consistent with the anesthetists' ratings with Spearman correlation coefficient of 0.877 (P < 0.001), affirming its capability to effectively capture the PIHI variations. The extra tree regression model outperformed the other models in predicting the ICV values with the smallest MAE (0.0512, 95% CI: 0.0511-0.0513), RMSE (0.0792, 95% CI: 0.0790-0.0794), and MAPE (0.2086, 95% CI: 0.2077-0.2095) and the largest R2 (0.9047, 95% CI: 0.9043-0.9052). It was found that the features of age and preoperative hemodynamic status were the most important features for accurately predicting the ICV values. CONCLUSIONS Our results demonstrate the potential of the machine learning approach in predicting PIHI index values, thereby preoperatively informing anesthetists the possible anesthetic risk and enabling the implementation of individualized and precise anesthesia interventions.
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Affiliation(s)
- Rigele Te
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Bo Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Isreal Deaconess Medical Center, Boston, MA, 02215, USA
| | - Xiuhua Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Shaohui Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Geqi Qi
- Key Laboratory of Transport Industry of Big Data Application Technologies for Comprehensive Transport, Beijing Jiaotong University, Beijing, 100044, China
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Schwalbe D, Timmermann C, Gregersen TA, Steffensen SV, Ammentorp J. Communication, Cognition and Competency Development in Healthcare: A Model for Integrating Cognitive Ethnography and Communication Skills Training in Clinical Interventions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231223319. [PMID: 38204973 PMCID: PMC10777782 DOI: 10.1177/23821205231223319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change. METHODS The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals' implementation and individual competency development, and support the design of in-situ simulation training scenarios. RESULTS Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance. CONCLUSION We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.
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Affiliation(s)
- Daria Schwalbe
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Culture and the Mind, Department of English, Germanic and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - Connie Timmermann
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Trine A Gregersen
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- Center for Ecolinguistics, South China Agricultural University, Guangzhou, China
- College of International Studies, Southwest University, Chongqing, China
| | - Jette Ammentorp
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
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Boyle JG, Walters MR, Jamieson S, Durning SJ. Distributed cognition: Theoretical insights and practical applications to health professions education: AMEE Guide No. 159. MEDICAL TEACHER 2023; 45:1323-1333. [PMID: 37043405 DOI: 10.1080/0142159x.2023.2190479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Distributed cognition (DCog) is a member of the family of situativity theories that widens the lens of cognition from occurring solely inside the head to being socially, materially and temporally distributed within a dynamic system. The concept of extending the view of cognition to outside the head of a single health professional is relatively new in the healthcare system. DCog has been increasingly used by researchers to describe many ways in which health professionals perform in teams within structured clinical environments to deliver healthcare for patients. In this Guide, we expound ten central tenets of the macro (grand) theory of DCog (1. Cognition is decentralized in a system; 2. The unit of analysis is the system; 3. Cognitive processes are distributed; 4. Cognitive processes emerge from interactions; 5. Cognitive processes are interdependent; 6. Social organization is a cognitive architecture; 7. Division of labour; 8. Social organization is a system of communication; 9. Buffering and filtering; 10. Cognitive processes are encultured) to provide theoretical insights as well as practical applications to the field of health professions education.
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Affiliation(s)
- James G Boyle
- Undergraduate Medical School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Matthew R Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Susan Jamieson
- Health Professions Education Programme, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Steven J Durning
- Center for Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Jebram L, Prediger S, Oubaid V, Harendza S. Matching of advanced undergraduate medical students' competence profiles with the required competence profiles of their specialty of choice for postgraduate training. BMC MEDICAL EDUCATION 2023; 23:647. [PMID: 37679688 PMCID: PMC10485971 DOI: 10.1186/s12909-023-04632-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Matching between undergraduate students and their chosen specialty has implications for their personal job satisfaction and performance as well as societies' needs regarding health care quality. Knowledge regarding student-specialty fit can help improve students' decisions and detect potential deficiencies in specific competences. In this study, we compare self-assessed competence profiles of medical students close to graduation with the competence profiles of their specialty of choice for postgraduate training. METHODS Self-assessed competence profiles were collected with the modified requirement-tracking (R-Track) questionnaire from 197 final-year medical students close to graduation in 2022. To determine student-specialty fit, difference scores between students' self-assessed competences and physicians' requirements for specific specialties were calculated across the R-Track's six competence areas "Motivation", "Personality traits", "Social interactive competences", "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities", which were assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Mean difference scores across competence areas were calculated and compared between specialties with multivariate analysis of variance. Student-specialty fit was also calculated independent of students' choices. RESULTS The competence area "Motivation" scored highest for both students and physicians across specialties. However, students' scores were lower than physicians' requirements for "Motivation" as well as "Personality traits" across all specialties. Difference scores for "Social interactive competences" were either close to zero or showed higher scores for students. A similar competence pattern for internal medicine, general medicine, paediatrics, and gynaecology was identified with higher than required student scores for "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities". All other specialties showed higher physicians' requirements for at least one of these competence areas. Independent of students' specialty choice, we found the highest difference score in favour of student scores for general medicine (0.31) and the lowest difference score for internal medicine (-0.02). CONCLUSIONS Students' competence profiles overall show better fit with person-oriented specialties. "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities" show higher requirement scores for more technique-oriented specialties. Students interested in such specialties could focus more on basic skill development in undergraduate training or will develop specific skills during residency.
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Affiliation(s)
- Lea Jebram
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Prediger
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Olin K, Klinga C, Ekstedt M, Pukk-Härenstam K. Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study. BMC Health Serv Res 2023; 23:651. [PMID: 37331961 DOI: 10.1186/s12913-023-09674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/08/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Safety has been described as a dynamic non-event and as constantly present in professionals' work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety - testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes. METHODS Individual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method. RESULTS During intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness. CONCLUSION Adequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation.
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Affiliation(s)
- Karolina Olin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
- Supervisory Centre, Wellbeing Services County of Southwest Finland, Turku, Finland.
| | - Charlotte Klinga
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Research and Development Unit for Elderly Persons (FOU Nu), Region Stockholm, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
- Department of Women and Children's Health, Karolinska University Hospital, Stockholm, Sweden
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Wakabayashi K, le Roux JJ, Jooma Z. Reclaiming the Etiquette of Extubation. Anesth Analg 2023; 136:1220-1226. [PMID: 37205806 DOI: 10.1213/ane.0000000000006307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Koji Wakabayashi
- From the Department of Anaesthesia, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Bergauer L, Braun J, Roche TR, Meybohm P, Hottenrott S, Zacharowski K, Raimann FJ, Rivas E, López-Baamonde M, Ganter MT, Nöthiger CB, Spahn DR, Tscholl DW, Akbas S. Avatar-based patient monitoring improves information transfer, diagnostic confidence and reduces perceived workload in intensive care units: computer-based, multicentre comparison study. Sci Rep 2023; 13:5908. [PMID: 37041316 PMCID: PMC10088750 DOI: 10.1038/s41598-023-33027-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 04/06/2023] [Indexed: 04/13/2023] Open
Abstract
Patient monitoring is the foundation of intensive care medicine. High workload and information overload can impair situation awareness of staff, thus leading to loss of important information about patients' conditions. To facilitate mental processing of patient monitoring data, we developed the Visual-Patient-avatar Intensive Care Unit (ICU), a virtual patient model animated from vital signs and patient installation data. It incorporates user-centred design principles to foster situation awareness. This study investigated the avatar's effects on information transfer measured by performance, diagnostic confidence and perceived workload. This computer-based study compared Visual-Patient-avatar ICU and conventional monitor modality for the first time. We recruited 25 nurses and 25 physicians from five centres. The participants completed an equal number of scenarios in both modalities. Information transfer, as the primary outcome, was defined as correctly assessing vital signs and installations. Secondary outcomes included diagnostic confidence and perceived workload. For analysis, we used mixed models and matched odds ratios. Comparing 250 within-subject cases revealed that Visual-Patient-avatar ICU led to a higher rate of correctly assessed vital signs and installations [rate ratio (RR) 1.25; 95% CI 1.19-1.31; P < 0.001], strengthened diagnostic confidence [odds ratio (OR) 3.32; 95% CI 2.15-5.11, P < 0.001] and lowered perceived workload (coefficient - 7.62; 95% CI - 9.17 to - 6.07; P < 0.001) than conventional modality. Using Visual-Patient-avatar ICU, participants retrieved more information with higher diagnostic confidence and lower perceived workload compared to the current industry standard monitor.
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Affiliation(s)
- Lisa Bergauer
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Julia Braun
- Department of Epidemiology and Biostatistics, University of Zurich, Zurich, Switzerland
| | - Tadzio Raoul Roche
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Sebastian Hottenrott
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Jürgen Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Eva Rivas
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Manuel López-Baamonde
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Michael Thomas Ganter
- Institute of Anaesthesiology and Critical Care Medicine, Clinic Hirslanden Zurich, Zurich, Switzerland
| | - Christoph Beat Nöthiger
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - David Werner Tscholl
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Samira Akbas
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Schaepkens SPC, Lijster T. Mind The Gap: A Philosophical Analysis of Reflection's Many Benefits. TEACHING AND LEARNING IN MEDICINE 2022:1-10. [PMID: 36475951 DOI: 10.1080/10401334.2022.2142794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/16/2022] [Indexed: 06/17/2023]
Abstract
Issue: Expectations of reflection run high in medical practice and medical education; it is claimed as a means to many ends. In this article, the authors do not reject the value of reflection for medical education and medical practitioners, but they still ask why reflection can (potentially) yield so many different benefits, and what that implies for the status of reflection in medical education practice. Evidence: Based on a conceptual analysis of debates about reflection in the philosophical tradition, the authors argue that there are two quintessential gaps that play a role in the proliferation of (potential) benefits. First, reflection deals with bridging the gap between theory and practice; second, it deals with bridging the gap between the individual sense and communal sense. These gaps prevent the systematization of reflection, and they are fundamental to human thinking and experience in any situated environment, which led contemporary research on reflection to list a wide variety of benefits. Implications: The authors argue that if reflection resists systematization, it cannot be learned by following rules or protocols, but only practiced. Then, reflection should no longer be taught and researched as an individual skill one learns, nor as a means to some particular, beneficial end. Rather, one should practice reflection, and experience what it means to be part of a community wherein professionals jump the theory-practice gap constantly in a myriad of situations. Based on their analysis, the authors provide three concrete recommendations for reflection in medical education. First, to give precedence to reflective activities that encompass both gaps wherein situated examples can flourish; second, to use reflective guidelines as sources of inspiration; third, to show reserve about assessing reflection.
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Affiliation(s)
| | - Thijs Lijster
- Faculty of Arts, University of Groningen, Groningen, The Netherlands
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Lewis K, O V, Garber AM, Sweet M, Novoa-Takara K, McConville J, Readlynn JK, Alweis R. AAIM Recommendations to Improve Learner Transitions. Am J Med 2022; 135:536-542. [PMID: 35038408 DOI: 10.1016/j.amjmed.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Kristen Lewis
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Valerie O
- Alliance for Academic Internal Medicine, Alexandria, Virginia
| | - Adam M Garber
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Michelle Sweet
- Rush Medical College of Rush University, Chicago, Illinois
| | | | | | - Jennifer K Readlynn
- University of Rochester School of Medicine and Dentistry,Rochester, New York
| | - Richard Alweis
- Rochester Regional Health, Lake Eric College of Osteopathic Medicine, Rochester, New York.
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Wetli DJ, Bergauer L, Nöthiger CB, Roche TR, Spahn DR, Tscholl DW, Said S. Improving Visual-Patient-Avatar Design Prior to Its Clinical Release: A Mixed Qualitative and Quantitative Study. Diagnostics (Basel) 2022; 12:diagnostics12020555. [PMID: 35204644 PMCID: PMC8871093 DOI: 10.3390/diagnostics12020555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
Visual-Patient-avatar, an avatar-based visualisation of patient monitoring, is a newly developed technology aiming to promote situation awareness through user-centred design. Before the technology’s introduction into clinical practice, the initial design used to validate the concept had to undergo thorough examination and adjustments where necessary. This mixed qualitative and quantitative study, consisting of three different study parts, aimed to create a design with high user acceptance regarding perceived professionalism and potential for identification while maintaining its original functionality. The first qualitative part was based on structured interviews and explored anaesthesia personnel’s first impressions regarding the original design. Recurrent topics were identified using inductive coding, participants’ interpretations of the vital sign visualisations analysed and design modifications derived. The second study part consisted of a redesign process, in which the visualisations were adapted according to the results of the first part. In a third, quantitative study part, participants rated Likert scales about Visual-Patient-avatar’s appearance and interpreted displayed vital signs in a computer-based survey. The first, qualitative study part included 51 structured interviews. Twenty-eight of 51 (55%) participants mentioned the appearance of Visual-Patient-avatar. In 23 of 51 (45%) interviews, 26 statements about the general impression were identified with a balanced count of positive (14 of 26) and negative (12 of 26) comments. The analysis of vital sign visualisations showed deficits in several vital sign visualisations, especially central venous pressure. These findings were incorporated into part two, the redesign of Visual-Patient-avatar. In the subsequent quantitative analysis of study for part three, 20 of 30 (67%) new participants agreed that the avatar looks professional enough for medical use. Finally, the participants identified 73% (435 of 600 cases) of all vital sign visualisations intuitively correctly without prior instruction. This study succeeded in improving the original design with good user acceptance and a reasonable degree of intuitiveness of the new, revised design. Furthermore, the study identified aspects relevant for the release of Visual-Patient-avatar, such as the requirement for providing at least some training, despite the design’s intuitiveness. The results of this study will guide further research and improvement of the technology. The study provides a link between Visual-Patient-avatar as a scientific concept and as an actual product from a cognitive engineering point of view, and may serve as an example of methods to study the designs of technologies in similar contexts.
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Ljubenovic A, Said S, Braun J, Grande B, Kolbe M, Spahn DR, Nöthiger CB, Tscholl DW, Roche TR. Anesthesia providers' visual attention in simulated anesthesia emergencies using conventional number-based and avatar-based patient monitoring: a prospective, eye-tracking study. JMIR Serious Games 2022; 10:e35642. [PMID: 35172958 PMCID: PMC8984829 DOI: 10.2196/35642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. OBJECTIVE The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. METHODS This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. RESULTS Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5 - 317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9 - 51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient -1.39; 95%CI: -2.44 to -0.34; P=.02), and the dwell time diminished by 0.23 seconds (coefficient -0.23; 95%CI: -0.4 to -0.06; P=.01). CONCLUSIONS Using eye-tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness. CLINICALTRIAL Business Management System for Ethics Committees Number Req-2020-00059.
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Affiliation(s)
- Arsène Ljubenovic
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Sadiq Said
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, CH
| | - Bastian Grande
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH.,Simulation Centre, University Hospital Zurich, Zurich, CH
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, CH
| | - Donat R Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - David W Tscholl
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Tadzio R Roche
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
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13
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Salmon PM, Plant KL. Distributed situation awareness: From awareness in individuals and teams to the awareness of technologies, sociotechnical systems, and societies. APPLIED ERGONOMICS 2022; 98:103599. [PMID: 34656892 DOI: 10.1016/j.apergo.2021.103599] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
A large component of Neville Stanton's work has focused on situation awareness in domains such as defence, transport, and process control. A significant contribution has been to initiate a shift from considering individual human operator situation awareness to considering the situation awareness of human and non-human teams, organisations, and even sociotechnical systems. Though controversial when introduced, the distributed situation awareness model has become increasingly relevant for modern day systems and problems. In this article we reflect on Stanton's contribution and point to a pressing need to consider a. The situation awareness of advanced technologies, and b. situation awareness at a sociotechnical system, societal and even global level. This is demonstrated via discussion on two contemporaneous issues: automated vehicles and the COVID-19 pandemic. It is concluded that, given advances such as artificial intelligence, the increased connectedness of society, emerging issues such as disinformation, and an increasing set of global threats, Stanton's distributed situation awareness model and associated analysis framework provide a useful toolkit for future Human Factors and Ergonomics applications.
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Affiliation(s)
- Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Maroochydore, QLD, 4558, Australia.
| | - Katherine L Plant
- Transportation Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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14
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Walshe N, Ryng S, Drennan J, O'Connor P, O'Brien S, Crowley C, Hegarty J. Situation awareness and the mitigation of risk associated with patient deterioration: A meta-narrative review of theories and models and their relevance to nursing practice. Int J Nurs Stud 2021; 124:104086. [PMID: 34601204 DOI: 10.1016/j.ijnurstu.2021.104086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/27/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accurate situation awareness has been identified as a critical component of effective deteriorating patient response systems and an essential patient safety skill for nursing practice. However, situation awareness has been defined and theorised from multiple perspectives to explain how individuals, teams and systems maintain awareness in dynamic task environments. AIM Our aim was to critically analyse the different approaches taken to the study of situation awareness in healthcare and explore the implications for nursing practice and research as it relates to clinical deterioration in ward contexts. METHODS We undertook a meta-narrative review of the healthcare literature to capture how situation awareness has been defined, theorised and studied in healthcare. Following an initial scoping review, we conducted an extensive search of ten electronic databases and included any theoretical, empirical or critical papers with a primary focus on situation awareness in an inpatient hospital setting. Included papers were collaboratively categorised in accordance with their theoretical framing, research tradition and paradigm with a narrative review presented. RESULTS A total of 120 papers were included in this review. Three overarching narratives reflecting philosophical, patient safety and solution focussed framings of situation awareness and seven meta-narratives were identified as follows: individual, team and systems perspectives of situation awareness (meta-narratives 1-3), situation awareness and patient safety (meta-narrative 4), communication tools, technologies and education to support situation awareness (meta-narratives 5-7). We identified a concentration of literature from anaesthesia and operating rooms and a body of research largely located within a cognitive engineering tradition and a positivist research paradigm. Endsley's situation awareness model was applied in over 80% of the papers reviewed. A minority of papers drew on alternative situation awareness theories including constructivist, collaborative and distributed perspectives. CONCLUSIONS Nurses have a critical role in identifying and escalating the care of deteriorating patients. There is a need to build on prior studies and reflect on the reality of nurse's work and the constraints imposed on situation awareness by the demands of busy inpatient wards. We suggest that this will require an analysis that complements but goes beyond the dominant cognitive engineering tradition to reflect the complex socio-cultural reality of ward-based teams and to explore how situation awareness emerges in increasingly complex, technologically enabled distributed healthcare systems.
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Affiliation(s)
- Nuala Walshe
- School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Stephanie Ryng
- School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Paul O'Connor
- Department of General Practice, National University of Ireland, Distillery Road, Newcastle, Co Galway H91 TK33, Ireland.
| | - Sinéad O'Brien
- School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Clare Crowley
- School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland.
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15
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Boquet A, Cohen T, Diljohn F, Cabrera J, Reeves S, Shappell S. A Theoretical Model of Flow Disruptions for the Anesthesia Team During Cardiovascular Surgery. J Patient Saf 2021; 17:e534-e539. [PMID: 28678115 DOI: 10.1097/pts.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This investigation explores flow disruptions observed during cardiothoracic surgery and how they serve to disconnect anesthesia providers from their primary task. We can improve our understanding of this disengagement by exploring what we call the error space or the accumulated time required to resolve disruptions. METHODS Trained human factors students observed 10 cardiac procedures for disruptions impacting the anesthesia team and recorded the time required to resolve these events. Observations were classified using a human factors taxonomy. RESULTS Of 301 disruptions observed, interruptions (e.g., those events related to alerts, distractions, searching activity, spilling/dropping, teaching moment, and task deviations) accounted for the greatest frequency of events (39.20%). The average amount of time needed for each disruption to be resolved was 48 seconds. Across 49.87 hours of observation, more than 4 hours were spent resolving disruptions to the anesthesia team's work flow. CONCLUSIONS By defining a calculable error space associated with these disruptions, this research provides a conceptual metric that can serve in the identification and design of targeted interventions. This method serves as a proactive approach for recognizing systemic threats, affording healthcare workers the opportunity to mitigate the development and incidence of preventable errors precedently.
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Affiliation(s)
- Albert Boquet
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Tara Cohen
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Fawaaz Diljohn
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Jennifer Cabrera
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Scott Reeves
- Medical University of South Carolina, Charleston, South Carolina
| | - Scott Shappell
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
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16
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Pollack AH, Mishra SR, Apodaca C, Khelifi M, Haldar S, Pratt W. Different roles with different goals: Designing to support shared situational awareness between patients and clinicians in the hospital. J Am Med Inform Assoc 2021; 28:222-231. [PMID: 33150394 PMCID: PMC7883969 DOI: 10.1093/jamia/ocaa198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Team situational awareness helps to ensure high-quality care and prevent errors in the complex hospital environment. Although extensive work has examined factors that contribute to breakdowns in situational awareness among clinicians, patients’ and caregivers’ roles have been neglected. To address this gap, we studied team-based situational awareness from the perspective of patients and their caregivers. Materials and Methods We utilized a mixed-methods approach, including card sorting and semi-structured interviews with hospitalized patients and their caregivers at a pediatric hospital and an adult hospital. We analyzed the results utilizing the situational awareness (SA) theoretical framework, which identifies 3 distinct stages: (1) perception of a signal, (2) comprehension of what the signal means, and (3) projection of what will happen as a result of the signal. Results A total of 28 patients and 19 caregivers across the 2 sites participated in the study. Our analysis uncovered how team SA helps patients and caregivers ensure that their values are heard, their autonomy is supported, and their clinical outcomes are the best possible. In addition, our participants described both barriers—such as challenges with communication—and enablers to facilitating shared SA in the hospital. Discussion Patients and caregivers possess critical knowledge, expertise, and values required to ensure successful and accurate team SA. Therefore, hospitals need to incorporate tools that facilitate patients and caregivers as key team members for effective SA. Conclusions Elevating patients and caregivers from passive recipients to equal contributors and members of the healthcare team will improve SA and ensure the best possible outcomes.
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Affiliation(s)
- Ari H Pollack
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sonali R Mishra
- Information School, University of Washington, Seattle, Washington, USA
| | - Calvin Apodaca
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Maher Khelifi
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Shefali Haldar
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
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17
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Soncrant C, Neily J, Sum-Ping SJT, Wallace AW, Mariano ER, Leissner KB, Mills PD, Mazzia L, Paull DE. Sharing Lessons Learned to Prevent Adverse Events in Anesthesiology Nationwide. J Patient Saf 2021; 17:e343-e349. [PMID: 31135598 DOI: 10.1097/pts.0000000000000616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Veterans Health Administration (VHA) lessons learned process for Anesthesia adverse events was developed to alert the field to the occurrences and prevention of actual adverse events. This article details this quality improvement project and perceived impact. METHODS As part of ongoing quality improvement, root cause analysis related to anesthesiology care are routinely reported to the VHA National Center for Patient Safety. Since May 2012, the National Anesthesia Service subject matter experts, in collaboration with National Center for Patient Safety, review actual adverse events in anesthesiology and detailed lessons learned are developed. A survey of anesthesiology chiefs to determine perceived usefulness and accessibility of the project was conducted in April 2018. RESULTS The distributed survey yielded a response rate of 69% (84/122). Most of those who have seen the lessons learned (85%, 71/84) found them valuable. Ninety percent of those aware of the lessons learned (64/71) shared them with staff and 75% (53/71) reported a changed or reinforced patient safety behavior in their facility. The lessons learned provided 72% (51/71) of chiefs with new knowledge about patient safety and 75% (53/71) gained new knowledge for preventing adverse events. CONCLUSIONS This nationwide VHA anesthesiology lessons learned project illustrates the tenets of a learning organization. implementing team and systems-based safeguards to mitigate risk of harm from inevitable human error. Sharing lessons learned provides opportunities for clinician peer-to-peer learning, communication, and proactive approaches to prevent future similar errors.
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Affiliation(s)
- Christina Soncrant
- From the Veterans' Health Administration, National Center for Patient Safety, Field Office, White River Junction, Vermont
| | - Julia Neily
- From the Veterans' Health Administration, National Center for Patient Safety, Field Office, White River Junction, Vermont
| | | | | | | | - Kay B Leissner
- Veterans Affairs Boston Healthcare System, Boston Massachusetts
| | | | - Lisa Mazzia
- Veterans' Health Administration, National Center for Patient Safety, Ann Arbor, Michigan
| | - Douglas E Paull
- Veterans' Health Administration, National Center for Patient Safety, Ann Arbor, Michigan
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18
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Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study. Br J Anaesth 2021; 126:1046-1054. [PMID: 33879327 DOI: 10.1016/j.bja.2021.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Failures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations. METHODS We conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9. RESULTS We analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96-1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83-1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13-2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=-23.0; 95% CI, -27.2 to -18.8; P<0.0001) and split-screen (-6.7; 95% CI, -10.9 to -2.4; P=0.002) compared with conventional. CONCLUSIONS This study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience.
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19
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Koufidis C, Manninen K, Nieminen J, Wohlin M, Silén C. Unravelling the polyphony in clinical reasoning research in medical education. J Eval Clin Pract 2021; 27:438-450. [PMID: 32573080 DOI: 10.1111/jep.13432] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE Clinical reasoning lies at the heart of medical practice and has a long research tradition. Nevertheless, research is scattered across diverse academic disciplines with different research traditions in a wide range of scientific journals. This polyphony is a source of conceptual confusion. AIMS AND OBJECTIVES We sought to explore the underlying theoretical assumptions of clinical reasoning aiming to promote a comprehensive conceptual and theoretical understanding of the subject area. In particular, we asked how clinical reasoning is defined and researched and what conceptualizations are relevant to such uses. METHODS A scoping review of the clinical reasoning literature was undertaken. Using a "snowball" search strategy, the wider scientific literature on clinical reasoning was reviewed in order to clarify the different underlying conceptual assumptions underlying research in clinical reasoning, particularly to the field of medical education. This literature included both medical education, as well as reasoning research in other academic disciplines outside medical education, that is relevant to clinical reasoning. A total of 124 publications were included in the review. RESULTS A detailed account of the research traditions in clinical reasoning research is presented. In reviewing this research, we identified three main conceptualisations of clinical reasoning: "reasoning as cognitive activity," "reasoning as contextually situated activity," and "reasoning as socially mediated activity." These conceptualisations reflected different theoretical understandings of clinical reasoning. Each conceptualisation was defined by its own set of epistemological assumptions, which we have identified and described. CONCLUSIONS Our work seeks to bring into awareness implicit assumptions of the ongoing clinical reasoning research and to hopefully open much needed channels of communication between the different research communities involved in clinical reasoning research in the field.
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Affiliation(s)
- Charilaos Koufidis
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Katri Manninen
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Juha Nieminen
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Charlotte Silén
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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20
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Sfez M, Derichard A. Première vague de COVID-19 : un retour d’expérience en clinique privée. ANESTHÉSIE & RÉANIMATION 2021. [PMCID: PMC7862924 DOI: 10.1016/j.anrea.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Secchi D, Cowley SJ. Cognition in Organisations: What it Is and how it Works. EUROPEAN MANAGEMENT REVIEW 2020. [DOI: 10.1111/emre.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Davide Secchi
- Research Centre for Computational & Organizational Cognition, Department of Language and Communication University of Southern Denmark–Slagelse Denmark
| | - Stephen J. Cowley
- Research Centre for Computational & Organizational Cognition, Department of Language and Communication University of Southern Denmark–Slagelse Denmark
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22
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Perkins EJ, Edelman DA, Brewster DJ. Smartphone use and perceptions of their benefit and detriment within Australian anaesthetic practice. Anaesth Intensive Care 2020; 48:366-372. [DOI: 10.1177/0310057x20947427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The primary aim of this study was to evaluate the perceptions of Australian anaesthetists in relation to smartphone use within anaesthetic practice. In particular, we aimed to assess the frequency of smartphone use, the types and number of smartphone applications used, how reliant anaesthetists perceive themselves to be on smartphones and whether they perceive them to be a factor that aids or distracts from their practice. Secondly, we assessed whether there is an association between the type, frequency, reliance and perceptions of smartphone use and the years of experience as an anaesthetist. A 24-item questionnaire addressing these questions was created and distributed to an email list of credentialled anaesthetists in Melbourne, Australia. A total of 113 consultant anaesthetists who practise at 55 hospitals in Melbourne completed the questionnaire. Our results suggest that the majority of anaesthetists are using smartphones regularly in their practice. About 74% of respondents agreed that they rely on their smartphone for their work. We found that respondents were more likely to rely on smartphones and consider them to aid patient safety than to consider them a distraction. This phenomenon was particularly apparent in those who had been a consultant anaesthetist for less than three years. Furthermore, those who had been a consultant anaesthetist for less than three years were more likely to have more smartphone apps relating to anaesthetics, use them more often and rely on them to a greater degree. Our results highlight the ubiquitous and perceived useful nature of smartphones in anaesthetic practice.
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Affiliation(s)
- Emma J Perkins
- Central Clinical School, Monash University, Melbourne, Australia
| | - Daniel A Edelman
- Central Clinical School, Monash University, Melbourne, Australia
| | - David J Brewster
- Central Clinical School, Monash University, Melbourne, Australia
- Cabrini Hospital, Malvern, Australia
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23
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Alhaider AA, Lau N, Davenport PB, Morris MK. Distributed situation awareness: a health-system approach to assessing and designing patient flow management. ERGONOMICS 2020; 63:682-709. [PMID: 32279607 DOI: 10.1080/00140139.2020.1755061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Patient flow management is a system-wide process but many healthcare providers do not integrate multiple departments into the process to minimise the time between treatments or medical services for maximum patient throughput. This paper presents a case study of applying Distributed Situation Awareness (DSA) to characterise system-wide patient flow management and identify opportunities for improvements in a healthcare system. This case study employed a three-part method of data elicitation, extraction, and representation to investigate DSA. Social, task, and knowledge networks were developed and then combined to characterise patient flow management and identify deficiencies of the command and control centre of a healthcare facility. Social network analysis provided centrality metrics to further characterise patient flow management. The DSA model helped identify design principles and deficiencies in managing patient flow. These findings indicate that DSA is promising for analysing patient flow management from a system-wide perspective. Practitioner summary: This article examines Distribution Situation Awareness (DSA) as an analysis framework to study system-wide patient flow management. The DSA yields social, task, and knowledge networks that can be combined to characterise patient flow and identify deficiencies in the system. DSA appears promising for analysing communication and coordination of complex systems. Abbreviations: CDM: critical decision method; CTaC: carilion transfer and communications center; EAST: event analysis systematic teamwork; ED: emergency department; DES: discrete event simulation; DSA: distributed situation awareness; SA: situation awareness; SNA: social network analysis.
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Affiliation(s)
- Abdulrahman A Alhaider
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
- Department of Mechanical and Industrial Engineering, College of Engineering, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Nathan Lau
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Paul B Davenport
- Carilion Transfer and Communications Centre, Carilion Clinic, Roanoke, VA, USA
| | - Melanie K Morris
- Carilion Transfer and Communications Centre, Carilion Clinic, Roanoke, VA, USA
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24
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Rössler J, Kaserer A, Albiez B, Braun J, Breckwoldt J, Spahn DR, Nöthiger C, Tscholl DW. Comparing Classroom Instruction to Individual Instruction as an Approach to Teach Avatar-Based Patient Monitoring With Visual Patient: Simulation Study. JMIR MEDICAL EDUCATION 2020; 6:e17922. [PMID: 32205304 PMCID: PMC7206517 DOI: 10.2196/17922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/26/2020] [Accepted: 03/23/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Visual Patient is an avatar-based alternative to standard patient monitor displays that significantly improves the perception of vital signs. Implementation of this technology in larger organizations would require it to be teachable by brief class instruction to large groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction to Visual Patient. OBJECTIVE In this study, we aimed to compare 2 different educational methods, one-on-one instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring. METHODS We presented 42 anesthesia providers with 30 minutes of class instruction on Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study who each received individual instruction (individual instruction group). After the instruction, the participants were shown monitors with either conventional displays or Visual Patient displays and were asked to interpret vital signs. In the class instruction group, the participants were shown scenarios for either 3 or 10 seconds, and the numbers of correct perceptions with each technology were compared. Then, the teaching efficacy of the class instruction was compared with that of the individual instruction in the historical sample by 2-way mixed analysis of variance and mixed regression. RESULTS In the class instruction group, when participants were presented with the 3-second scenario, there was a statistically significant median increase in the number of perceived vital signs when the participants were shown the Visual Patient compared to when they were shown the conventional display (3 vital signs, P<.001; effect size -0.55). No significant difference was found for the 10-second scenarios. There was a statistically significant interaction between the teaching intervention and display technology in the number of perceived vital signs (P=.04; partial η2=.076). The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95% CI 1.41-2.52; P<.001) for individual instruction compared to class instruction as well as an OR of 3.03 (95% CI 2.50-3.70; P<.001) for the Visual Patient compared to conventional monitoring. CONCLUSIONS Although individual instruction on Visual Patient is slightly more effective, class instruction is a viable teaching method; thus, large-scale introduction of health care providers to this novel technology is feasible.
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Affiliation(s)
| | | | | | - Julia Braun
- Biostatistics and Prevention Institute, Departments of Epidemiology and Biostatistics, University of Zurich, Zurich, Switzerland
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Tscholl DW, Rössler J, Said S, Kaserer A, Spahn DR, Nöthiger CB. Situation Awareness-Oriented Patient Monitoring with Visual Patient Technology: A Qualitative Review of the Primary Research. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2112. [PMID: 32283625 PMCID: PMC7180744 DOI: 10.3390/s20072112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
Visual Patient technology is a situation awareness-oriented visualization technology that translates numerical and waveform patient monitoring data into a new user-centered visual language. Vital sign values are converted into colors, shapes, and rhythmic movements-a language humans can easily perceive and interpret-on a patient avatar model in real time. In this review, we summarize the current state of the research on the Visual Patient, including the technology, its history, and its scientific context. We also provide a summary of our primary research and a brief overview of research work on similar user-centered visualizations in medicine. In several computer-based studies under various experimental conditions, Visual Patient transferred more information per unit time, increased perceived diagnostic certainty, and lowered perceived workload. Eye tracking showed the technology worked because of the way it synthesizes and transforms vital sign information into new and logical forms corresponding to the real phenomena. The technology could be particularly useful for improving situation awareness in settings with high cognitive demand or when users must make quick decisions. This comprehensive review of Visual Patient research is the foundation for an evaluation of the technology in clinical applications, starting with a high-fidelity simulation study in early 2020.
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Affiliation(s)
- David Werner Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (J.R.); (S.S.); (A.K.); (D.R.S.); (C.B.N.)
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Garot O, Rössler J, Pfarr J, Ganter MT, Spahn DR, Nöthiger CB, Tscholl DW. Avatar-based versus conventional vital sign display in a central monitor for monitoring multiple patients: a multicenter computer-based laboratory study. BMC Med Inform Decis Mak 2020; 20:26. [PMID: 32041584 PMCID: PMC7011453 DOI: 10.1186/s12911-020-1032-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintaining adequate situation awareness is crucial for patient safety. Previous studies found that the use of avatar-based monitoring (Visual Patient Technology) improved the perception of vital signs compared to conventional monitoring showing numerical and waveform data; and was further associated with a reduction of perceived workload. In this study, we aimed to evaluate the effectiveness of Visual Patient Technology on perceptive performance and perceived workload when monitoring multiple patients at the same time, such as in central station monitors in intensive care units or operating rooms. METHODS A prospective, within-subject, computer-based laboratory study was performed in two tertiary care hospitals in Switzerland in 2018. Thirty-eight physician and nurse anesthetists volunteered for the study. The participants were shown four different central monitor scenarios in sequence, where each scenario displayed two critical and four healthy patients simultaneously for 10 or 30 s. After each scenario, participants had to recall the vital signs of the critical patients. Perceived workload was assessed with the National Aeronautics and Space Administration Task-Load-Index (NASA TLX) questionnaire. RESULTS In the 10-s scenarios, the median number of remembered vital signs significantly improved from 7 to 11 using avatar-based versus conventional monitoring with a mean of differences of 4 vital signs, 95% confidence interval (CI) 2 to 6, p < 0.001. At the same time, the median NASA TLX scores were significantly lower for avatar-based monitoring (67 vs. 77) with a mean of differences of 6 points, 95% CI 0.5 to 11, p = 0.034. In the 30-s scenarios, vital sign perception and workload did not differ significantly. CONCLUSIONS In central monitor multiple patient monitoring, we found a significant improvement of vital sign perception and reduction of perceived workload using Visual Patient Technology, compared to conventional monitoring. The technology enabled improved assessment of patient status and may, thereby, help to increase situation awareness and enhance patient safety.
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Affiliation(s)
- Olivier Garot
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Julian Rössler
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Juliane Pfarr
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael T Ganter
- Institute of Anesthesiology and Pain Therapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Pfarr J, Ganter MT, Spahn DR, Noethiger CB, Tscholl DW. Effects of a standardized distraction on caregivers’ perceptive performance with avatar-based and conventional patient monitoring: a multicenter comparative study. J Clin Monit Comput 2019; 34:1369-1378. [DOI: 10.1007/s10877-019-00429-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
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Pfarr J, Ganter MT, Spahn DR, Noethiger CB, Tscholl DW. Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study. J Med Internet Res 2019; 21:e13041. [PMID: 31317870 PMCID: PMC6668297 DOI: 10.2196/13041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/03/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Continuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms. OBJECTIVE In this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers' perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only. METHODS We conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision. RESULTS Overall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 (P<.001) in scenario 1, and more than doubled from 3 to 8 (P<.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 (P<.001), and very unconfident in scenario 2 (P=.024) with conventional monitoring. CONCLUSIONS This study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior to a standard numeric display for peripheral vision. Avatar-based monitoring could potentially make much more of the patient monitoring information available to caregivers for longer time periods per case. Our results indicate that the optimal information transmission would consist of a combination of auditory and avatar-based monitoring.
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Affiliation(s)
- Juliane Pfarr
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Michael T Ganter
- Institute of Anesthesiology Kantonsspital Winterthur, Winterthur, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Christoph B Noethiger
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
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Klueber S, Wolf E, Grundgeiger T, Brecknell B, Mohamed I, Sanderson P. Supporting multiple patient monitoring with head-worn displays and spearcons. APPLIED ERGONOMICS 2019; 78:86-96. [PMID: 31046963 DOI: 10.1016/j.apergo.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
In hospitals, clinicians often need to monitor several patients while performing other tasks. However, visual displays that show patients' vital signs are in fixed locations and auditory alarms intended to alert clinicians may be missed. Information such as spearcons (time-compressed speech earcons) that 'travels' with the clinician and is delivered by earpiece and/or head-worn displays (HWDs), might overcome these problems. In this study, non-clinicians monitored five simulated patients in three 10-min scenarios while performing a demanding tracking task. Monitoring accuracy was better for participants using spearcons and a HWD (88.7%) or a HWD alone (86.2%) than for participants using spearcons alone (74.1%). Participants using the spearcons and HWD (37.7%) performed the tracking task no differently from participants using spearcons alone (37.1%) but participants using the HWD alone performed worse overall (33.1%). The combination of both displays may be a suitable solution for monitoring multiple patients.
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Affiliation(s)
- Sara Klueber
- Institute Human-Computer-Media, University of Würzburg, Germany.
| | - Erik Wolf
- Institute Human-Computer-Media, University of Würzburg, Germany
| | | | - Birgit Brecknell
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Ismail Mohamed
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, Brisbane, Australia; School of Medicine and School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Berveiller P, Rousseau A, Tastard M, Raynal P. [An introduction to human factors: From aeronautic to obstetrics]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2019; 47:527-534. [PMID: 31003012 DOI: 10.1016/j.gofs.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 06/09/2023]
Abstract
The theme of human factors is becoming more and more prominent in the healthcare field. Indeed, despite their expertise, healthcare providers display the same limits, those of any human being working in a team, in a system that requires high-reliability. Error is inherent in all human activity. Therefore, the study of human factors makes a perfect sense. The aim of our article is to provide to readers general and recent information on the concept of human factors, and to introduce other related notions such as "error", "fault", non-punishment of error, leadership, crew resource management, situation awareness. Indeed, in some teams, a lack of situation awareness, a poor communication, or an inadequate leadership may lead to a deteriorated clinical situation, leading to a significant and unbearable risk to our pregnant patients. We have a lot to learn from other professional systems that require high-reliability such as aeronautic, military and nuclear field for example. Thus, understanding a teamwork running and the genesis of the errors, developing some notions as illustrated by non-punishment of the error occurrence, debriefings, maintenance of regular staffs, high-fidelity simulation may allow the teams to evolve in a safer system for our pregnant patients.
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Affiliation(s)
- P Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy Saint Germain, 10, rue du champ Gaillard, 78300 Poissy, France; EA7404 (GIG) - UFR Simone Veil, Montigny-Le-Bretonneux, France; Réseau de périnatalité Maternité en Yvelines et Périnatalité Active (MYPA).
| | - A Rousseau
- Département de Maïeutique, UFR Simone Veil, 78180 Montigny-Le-Bretonneux, France; Unité EA 7285 RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », 78180 Montigny-Le-Bretonneux, France
| | - M Tastard
- Officier Pilote de ligne, Boeing 777, Air France, 45 rue de Paris, 95747 Roissy CDG Cedex, France
| | - P Raynal
- Réseau de périnatalité Maternité en Yvelines et Périnatalité Active (MYPA); Service de gynéologie-obstétrique, centre hospitalier de Versailles, 78150 Le Chesnay, France
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Pennington B, Garside J. The perioperative Team Brief: A patient safety initiative or another tick-box exercise? J Perioper Pract 2019; 29:408-412. [PMID: 31135285 DOI: 10.1177/1750458919845828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Health Organization Surgical Safety Checklist has been the subject of many professional discussions following its introduction in 2008. Since the addition of the Team Brief and Debrief in 2010 and the acceptance of the Five Steps to Safer Surgery as the gold standard, compliance has steadily improved (as audited by Care Quality Commission Inspections). This review of the literature therefore examined the perioperative Team Brief and identified gaps in knowledge. Evidence appears to suggest that whilst compliance is good in quantitative terms, there may be inconsistencies within the quality of Team Briefs from organisation to organisation and surgeon to surgeon. Concluding further research is required to establish what an effective Team Brief looks, sounds and feels like to all involved.
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Affiliation(s)
- Bernard Pennington
- Human and Health Science, University of Huddersfield, West Yorkshire, UK
| | - Joanne Garside
- Human and Health Science, University of Huddersfield, West Yorkshire, UK
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Tscholl DW, Handschin L, Rössler J, Weiss M, Spahn DR, Nöthiger CB. It's not you, it's the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study. BMC Anesthesiol 2019; 19:87. [PMID: 31138143 PMCID: PMC6540409 DOI: 10.1186/s12871-019-0757-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions from the information displayed on patient monitors. Previous research has shown that today’s patient monitoring has room for improvement in areas such as information overload and alarm fatigue. The rationale of this study was to learn more about the problems anesthesiologists face in patient monitoring and to derive improvement suggestions for next-generation patient monitors. Methods We conducted a two-center qualitative/quantitative study. Initially, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: common problems with patient monitoring in your daily work. Through deductive and inductive coding, we identified major topics and sub themes from the interviews. In a second step, a field survey, a separate group of 25 anesthesiologists rated their agree- or disagreement with central statements created for all identified major topics. Results We identified the following six main topics: 1. “Alarms,” 2. “Artifacts,” 3. “Software,” 4. “Hardware,” 5. “Human Factors,” 6. “System Factors,” and 17 sub themes. The central statements rated for the major topics were: 1. “problems with alarm settings complicate patient monitoring.” (56% agreed) 2. “artifacts complicate the assessment of the situation.” (64% agreed) 3. “information overload makes it difficult to get an overview quickly.” (56% agreed) 4. “problems with cables complicate working with patient monitors.” (92% agreed) 5. “factors related to human performance lead to critical information not being perceived.” (88% agreed) 6. “Switching between monitors from different manufacturers is difficult.” (88% agreed). The ratings of all statements differed significantly from neutral (all p < 0.03). Conclusion This study provides an overview of the problems anesthesiologists face in patient monitoring. Some of the issues, to our knowledge, were not previously identified as common problems in patient monitoring, e.g., hardware problems (e.g., cable entanglement and worn connectors), human factor aspects (e.g., fatigue and distractions), and systemic factor aspects (e.g., insufficient standardization between manufacturers). An ideal monitor should transfer the relevant patient monitoring information as efficiently as possible, prevent false positive alarms, and use technologies designed to improve the problems in patient monitoring. Electronic supplementary material The online version of this article (10.1186/s12871-019-0757-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David W Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Lucas Handschin
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Julian Rössler
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Mona Weiss
- Department of Management, School of Business and Economics, Free University of Berlin, Garystrasse 21, 14195, Berlin, Germany
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Loh HP, De Korne DF, Yin SQ, Ang E, Lau Y. Assessment of Scrub Practitioners’ List of Intraoperative Non‐Technical Skills (SPLINTS) in an Asian Ambulatory Surgical Setting. AORN J 2019; 109:465-476. [DOI: 10.1002/aorn.12640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tscholl DW, Weiss M, Handschin L, Spahn DR, Nöthiger CB. User perceptions of avatar-based patient monitoring: a mixed qualitative and quantitative study. BMC Anesthesiol 2018; 18:188. [PMID: 30537934 PMCID: PMC6290504 DOI: 10.1186/s12871-018-0650-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new patient monitoring technology called Visual Patient, which transforms numerical and waveform data into a virtual model (an avatar) of the monitored patient, has been shown to improve the perception of vital signs compared to conventional patient monitoring. In order to gain a deeper understanding of the opinions of potential future users regarding the new technology, we have analyzed the answers of two large groups of anesthetists using two different study methods. METHODS First, we carried out a qualitative analysis guided by the "consolidated criteria for reporting qualitative research" checklist. For this analysis, we interviewed 128 anesthesiologists, asking: "Where do you see advantages in Visual Patient monitoring?" and afterward identified major and minor themes in their answers. In a second study, an online survey with 38 anesthesiologists at two different institutions, we added a quantitative part in which anesthesiologists rated statements based on the themes identified in the prior analysis on an ordinal rating scale. RESULTS We identified four high-level themes: "quick situation recognition," "intuitiveness," "unique design characteristics," and "potential future uses," and eight subthemes. The quantitative questions raised for each major theme were: 1. "The Visual Patient technology enabled me to get a quick overview of the situation." (63% of the participants agreed or very much agreed to this statement). 2. "I found the Visual Patient technology to be intuitive and easy to learn." (82% agreed or very much agreed to this statement). 3. "The visual design features of the Visual Patient technology (e.g., the avatar representation) are not helpful for patient monitoring." (11% agreed to this statement). 4. "I think the Visual Patient technology might be helpful for non-monitor experts (e.g., surgeons) in the healthcare system." (53% of the participants agreed or strongly agreed). CONCLUSION This mixed method study provides evidence that the included anesthesiologists considered the new avatar-based technology to be intuitive and easy to learn and that the technology enabled them to get an overview of the situation quickly. Only a few users considered the avatar presentation to be unhelpful for patient monitoring and about half think it might be useful for non-experts.
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Affiliation(s)
- David W Tscholl
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Mona Weiss
- Leipzig University, Städtisches Kaufhaus, 04109, Leipzig, Germany
| | - Lucas Handschin
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Using an animated patient avatar to improve perception of vital sign information by anaesthesia professionals. Br J Anaesth 2018; 121:662-671. [DOI: 10.1016/j.bja.2018.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/22/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
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Kandler L, Tscholl DW, Kolbe M, Seifert B, Spahn DR, Noethiger CB. Using educational video to enhance protocol adherence for medical procedures. Br J Anaesth 2018; 116:662-9. [PMID: 27106970 DOI: 10.1093/bja/aew030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol. METHODS We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines. RESULTS The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27-0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (all P<0.001). CONCLUSIONS This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.
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Affiliation(s)
- Lukas Kandler
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Michaela Kolbe
- Organization, Work and Technology Group, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland Quality Management and Patient Safety, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Burkhardt Seifert
- Biostatistics, Epidemiology, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christoph B Noethiger
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Marshall DC, Finlayson MP. Identifying the nontechnical skills required of nurses in general surgical wards. J Clin Nurs 2018; 27:1475-1487. [DOI: 10.1111/jocn.14290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 02/04/2023]
Affiliation(s)
| | - Mary P Finlayson
- College of Nursing and Midwifery; Charles Darwin University; Darwin Australia
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Jones CPL, Fawker-Corbett J, Groom P, Morton B, Lister C, Mercer SJ. Human factors in preventing complications in anaesthesia: a systematic review. Anaesthesia 2018; 73 Suppl 1:12-24. [DOI: 10.1111/anae.14136] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/17/2022]
Affiliation(s)
- C. P. L. Jones
- Aintree University Hospital NHS Foundation Trust; Longmoor Lane, Aintree; Liverpool UK
- Defence Medical Services; Royal Centre for Defence Medicine; Queen Elizabeth Hospital Birmingham; Mindelsohn Way, Edgbaston; Birmingham UK
| | - J. Fawker-Corbett
- Aintree University Hospital NHS Foundation Trust; Longmoor Lane, Aintree; Liverpool UK
| | - P. Groom
- Aintree University Hospital NHS Foundation Trust; Longmoor Lane, Aintree; Liverpool UK
| | - B. Morton
- Aintree University Hospital NHS Foundation Trust; Longmoor Lane, Aintree; Liverpool UK
- Liverpool School of Tropical Medicine; Pembroke Place; Liverpool UK
| | - C. Lister
- Aintree University Hospital NHS Foundation Trust; Longmoor Lane, Aintree; Liverpool UK
| | - S. J. Mercer
- Aintree University Hospital NHS Foundation Trust; Longmoor Lane, Aintree; Liverpool UK
- Defence Medical Services; Royal Centre for Defence Medicine; Queen Elizabeth Hospital Birmingham; Mindelsohn Way, Edgbaston; Birmingham UK
- Postgraduate School of Medicine; University of Liverpool; Cedar House, Ashton Street; Liverpool UK
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Frequency and Type of Situational Awareness Errors Contributing to Death and Brain Damage: A Closed Claims Analysis. Anesthesiology 2017; 127:326-337. [PMID: 28459735 DOI: 10.1097/aln.0000000000001661] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Situational awareness errors may play an important role in the genesis of patient harm. The authors examined closed anesthesia malpractice claims for death or brain damage to determine the frequency and type of situational awareness errors. METHODS Surgical and procedural anesthesia death and brain damage claims in the Anesthesia Closed Claims Project database were analyzed. Situational awareness error was defined as failure to perceive relevant clinical information, failure to comprehend the meaning of available information, or failure to project, anticipate, or plan. Patient and case characteristics, primary damaging events, and anesthesia payments in claims with situational awareness errors were compared to other death and brain damage claims from 2002 to 2013. RESULTS Anesthesiologist situational awareness errors contributed to death or brain damage in 198 of 266 claims (74%). Respiratory system damaging events were more common in claims with situational awareness errors (56%) than other claims (21%, P < 0.001). The most common specific respiratory events in error claims were inadequate oxygenation or ventilation (24%), difficult intubation (11%), and aspiration (10%). Payments were made in 85% of situational awareness error claims compared to 46% in other claims (P = 0.001), with no significant difference in payment size. Among 198 claims with anesthesia situational awareness error, perception errors were most common (42%), whereas comprehension errors (29%) and projection errors (29%) were relatively less common. CONCLUSIONS Situational awareness error definitions were operationalized for reliable application to real-world anesthesia cases. Situational awareness errors may have contributed to catastrophic outcomes in three quarters of recent anesthesia malpractice claims.Situational awareness errors resulting in death or brain damage remain prevalent causes of malpractice claims in the 21st century.
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Crane MF, Brouwers S, Forrest K, Tan S, Loveday T, Wiggins MW, Munday C, David L. Positive Affect Is Associated With Reduced Fixation in a Realistic Medical Simulation. HUMAN FACTORS 2017; 59:821-832. [PMID: 28704628 DOI: 10.1177/0018720817695191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study extends previous research by exploring the association between mood states (i.e., positive and negative affect) and fixation in practicing anesthetists using a realistic medical simulation. BACKGROUND The impact of practitioner emotional states on fixation is a neglected area of research. Emerging evidence is demonstrating the role of positive affect in facilitating problem solving and innovation, with demonstrated implications for practitioner fixation. METHOD Twelve practicing anesthetists (4 females; Mage= 39 years; SD = 6.71) were involved in a medical simulation. Prior to the simulation, practitioners rated the frequency they had experienced various positive and negative emotions in the previous three days. During the simulation, the patient deteriorated rapidly, and anesthetists were observed for their degree of fixation. After the simulation, practitioners indicated the frequency of these same emotions during the simulation. RESULTS Nonparametric correlations were used to explore the independent relationships between positive and negative affect and the behavioral measures. Only positive affect impacted the likelihood of fixation. Anesthetists who reported more frequent recent positive affect in the three days prior to the simulation and during the simulation tended to be less fixated as judged by independent raters, identified a decline in patient oxygen saturation more quickly, and more rapidly implemented the necessary intervention (surgical cricothyroidotomy). CONCLUSION These findings have some real-world implications for positive affect in patient safety. APPLICATION This research has broad implications for professions where fixation may impair practice. This research suggests that professional training should teach practitioners to identify their emotions and understand the role of these emotions in fixation.
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Exploring anesthesiologists' understanding of situational awareness: a qualitative study. Can J Anaesth 2017; 64:810-819. [PMID: 28573361 DOI: 10.1007/s12630-017-0904-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/21/2017] [Accepted: 05/19/2017] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This study explored how anesthesiologists understand situational awareness (SA) and how they think SA is learned, taught, and assessed. METHODS Semi-structured interviews were performed with practicing anesthesiologists involved in teaching. This qualitative study was conducted using constructivist grounded theory techniques (i.e., line-by-line coding, memoing, and constant comparison) in a thematic analysis of interview transcripts. Group meetings were held to develop and review themes emerging from the data. RESULTS Eighteen anesthesiologists were interviewed. Respondents displayed an understanding of SA using a mixture of examples from clinical experience and everyday life. Despite agreeing on the importance of SA, formal definitions of SA were lacking, and the participants did not explicate the topic of SA in either their practice or their teaching activities. Situational awareness had been learned informally through increasing independence in the clinical context, role modelling, reflection on errors, and formally through simulation. Respondents taught SA through modelling and discussing scanning behaviour, checklists, verbalization of thought processes, and debriefings. Although trainees' understanding of SA was assessed as part of the decision-making process for granting clinical independence, respondents found it difficult to give meaningful feedback on SA to their trainees. CONCLUSION Although SA is an essential concept in anesthesiology, its use remains rather tacit, primarily due to the lack of a common operational definition of the term. Faculty development is required to help anesthesiologists teach and assess SA more explicitly in the clinical environment.
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Stanton NA, Salmon PM, Walker GH, Salas E, Hancock PA. State-of-science: situation awareness in individuals, teams and systems. ERGONOMICS 2017; 60:449-466. [PMID: 28051356 DOI: 10.1080/00140139.2017.1278796] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Our review addresses one of the most used, but debated, topics in Ergonomics: Situation Awareness (SA). We examine and elaborate upon key SA models. These models are divided into individual SA, team SA and systems SA categories. Despite, or perhaps because of, the debates surrounding SA it remains an enduring theme for research and practice in the domain of Ergonomics, now for over two decades. A contingent approach, which seeks to match different models of SA to different types of ergonomics problem, enables the differences between positions to be revealed and reconciled, and the practitioner guided towards optimum methodological solutions. Practitioner Summary: Measuring SA in individuals, teams and systems has become a key objective in Ergonomics. One single approach to SA does not fit all problems encountered. This review shows the importance of considering all three types of models and achieving a match between them and the problem at hand.
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Affiliation(s)
- N A Stanton
- a Human Factors Engineering, Transportation Research Group, Civil, Maritime, Environmental Engineering and Science, Faculty of Engineering and the Environment, Bouldrewood Innovation Campus , University of Southampton , Southampton , UK
| | - P M Salmon
- b Faculty of Arts and Business, Centre for Human Factors and Sociotechnical Systems , University of the Sunshine Coast , Queensland , Australia
| | - G H Walker
- c Centre for Sustainable Road Freight , Heriot-Watt University , Edinburgh , UK
| | - E Salas
- d Department of Psychology , Rice University , Houston , TX , USA
| | - P A Hancock
- e Department of Psychology , University of Central Florida , Orlando , FL , USA
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Aiming for excellence – A simulation-based study on adapting and testing an instrument for developing non-technical skills in Norwegian student nurse anaesthetists. Nurse Educ Pract 2017; 22:37-46. [DOI: 10.1016/j.nepr.2016.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/11/2016] [Accepted: 11/28/2016] [Indexed: 11/21/2022]
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Eskandari N, Wang ZJ, Dumont GA. A delayed functional observer/predictor with bounded-error for depth of hypnosis monitoring. J Clin Monit Comput 2016; 31:1043-1052. [PMID: 27590919 DOI: 10.1007/s10877-016-9929-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/19/2016] [Indexed: 11/24/2022]
Abstract
With the motivation of providing safety for a patient under anesthesia, this paper suggests conditions for evaluating the correctness of an available user interface for systems under shared control based on observability and predictability requirements. Situation awareness is necessary for the user to make correct decisions about the inputs. In this article, we develop a technique to investigate the conditions under which an anesthetists can attain situation awareness about a limited but important aspect of anesthesia, namely depth of hypnosis (DOH). Furthermore, we consider that, in practice, to attain situation awareness, the estimation of the task states does not necessarily need to be precise but can be bounded within certain margins. Hence, attaining situation awareness about DOH is modeled as a bounded-error delayed functional observation/prediction. Unless such an observer/predictor exists for a system with a given user-interface, the safety of the operation may be compromised. The suggested technique proves that, in order to provide safety for the patient under anesthesia, it is necessary for the anesthetist to have access to the predictive information from a clinical decision support system.
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Affiliation(s)
- Neda Eskandari
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.
| | - Z Jane Wang
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Guy A Dumont
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
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Green B, Parry D, Oeppen RS, Plint S, Dale T, Brennan PA. Situational awareness - what it means for clinicians, its recognition and importance in patient safety. Oral Dis 2016; 23:721-725. [DOI: 10.1111/odi.12547] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- B Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - D Parry
- Department of Anatomy; Guys Hospital; London UK
| | - RS Oeppen
- Department of Radiology; University Hospital; Southampton UK
| | - S Plint
- Wessex HEE; Otterbourne Hampshire UK
| | - T Dale
- Atrainability Limited; Surrey UK
| | - PA Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
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Drake-Brockman TFE, Datta A, von Ungern-Sternberg BS. Patient monitoring with Google Glass: a pilot study of a novel monitoring technology. Paediatr Anaesth 2016; 26:539-46. [PMID: 26992465 DOI: 10.1111/pan.12879] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Head-mounted devices (HMDs) are of significant interest for applications within medicine, including in anesthesia for patient monitoring. Previous devices trialed in anesthesia for this purpose were often bulky, involved cable tethers, or were otherwise ergonomically infeasible. Google Glass is a modern HMD that is lightweight and solves many of the issues identified with previous HMDs. AIM To examine the acceptance of Google Glass as a patient monitoring device in a pediatric anesthesia context at Princess Margaret Hospital for Children, Perth, Australia. METHODS We developed a custom-designed software solution for integrating Google Glass into the anesthesia environment, which enabled the device user to continuously view patient monitoring parameters transmitted wirelessly from the anesthesia workstation. RESULTS A total of 40 anesthetists were included in the study. Each anesthetist used the device for the duration of a theater list. We found 90% of anesthetists trialing the device agreed that it was comfortable to wear, 86% agreed the device was easy to read, and 82.5% agreed the device was not distracting. In 75% of cases, anesthetists reported unprompted that they were comfortable using the device in theater. Anesthetists reported that they would use the device again in 76% of cases, and indicated that they would recommend the device to a colleague in 58% of cases. CONCLUSION Given the pilot nature of this study, we consider these results highly favorable. Anesthetists readily accepted Google Glass in the anesthetic environment, with further enhancements to device software, rather than hardware, now being the barrier to adoption. There are a number of applications for HMDs in pediatric anesthesia.
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Affiliation(s)
- Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia.,School of Computer Science and Software Engineering, The University of Western Australia, Perth, WA, Australia
| | - Amitava Datta
- School of Computer Science and Software Engineering, The University of Western Australia, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
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Lowe DJ, Ireland AJ, Ross A, Ker J. Exploring situational awareness in emergency medicine: developing a shared mental model to enhance training and assessment. Postgrad Med J 2016; 92:653-658. [PMID: 27129912 DOI: 10.1136/postgradmedj-2015-133772] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/17/2016] [Accepted: 03/30/2016] [Indexed: 11/03/2022]
Abstract
Non-technical skills (NTS) are gaining increasing prominence within the field of emergency medicine. Situational awareness (SA), one key component of NTS, is a key skill for emergency physicians (EPs) during initial training and throughout their career. Furthermore, the majority of frameworks used to evaluate clinical performance incorporate SA as one key component. This review seeks to define and explore the concept of SA within the context of emergency medicine. We describe SA at an individual, team and departmental level. Development of this ability enables EPs to function effectively within the challenging environment of the emergency department (ED). Enhancing our understanding of SA may develop the cognitive process that underpins our clinical performance. We propose a model for consideration to support evaluation and training of SA within the ED, linking the model to the novice expert continuum.
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Affiliation(s)
- David J Lowe
- Department of Emergency, Glasgow Royal Infirmary, Glasgow, UK.,Department of Anaesthesia, Critical Care & Pain, University of Glasgow, Glasgow, UK
| | | | - Al Ross
- Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jean Ker
- Clinical Skills Centre, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
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Attri JP, Khetarpal R, Chatrath V, Kaur J. Concerns about usage of smartphones in operating room and critical care scenario. Saudi J Anaesth 2016; 10:87-94. [PMID: 26952181 PMCID: PMC4760050 DOI: 10.4103/1658-354x.169483] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Smartphones and tablets have taken a central place in the lives of health care professionals. Their use has dramatically improved the communication and has become an important learning tool as the medical information can be assessed online at anytime. In critical care settings, use of smartphone facilitates quick passage of information through E-mail messaging and getting feedback from the concerned physician quickly, thereby reducing medical errors. However, in addition to the benefits offered, these devices have become a significant source of nosocomial infections, distraction for medical professionals and interfere with medical equipments. They may also put privacy and security of patients at stake. The benefits could be severely undermined if abuse and over use are not kept in check. This review article focuses on various applications of smartphones in healthcare practices, drawback of the use of these devices and the recommendations regarding the safe use of these devices.
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Affiliation(s)
- J P Attri
- Department of Anesthesia, Government Medical College, Amritsar, Punjab, India
| | - R Khetarpal
- Department of Anesthesia, Government Medical College, Amritsar, Punjab, India
| | - V Chatrath
- Department of Anesthesia, Government Medical College, Amritsar, Punjab, India
| | - J Kaur
- Department of Anesthesia, Government Medical College, Amritsar, Punjab, India
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Chatzimichailidou MM, Dokas IM. Introducing RiskSOAP to communicate the distributed situation awareness of a system about safety issues: an application to a robotic system. ERGONOMICS 2016; 59:409-422. [PMID: 26230156 DOI: 10.1080/00140139.2015.1075067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper introduces the RiskSOAP ('RiskSOAP' is the abbreviation for Risk SituatiOn Awareness Provision.) indicator to measure the capability of a complex socio-technical system to provide its agents with situation awareness (SA) about the presence of its threats and vulnerabilities and enables analysts to assess distributed SA. The RiskSOAP methodology adopts a comparative approach between two design versions of a system differing in the elements and characteristics that can enhance or cause the degradation of the awareness provision capability. The methodology uniquely combines three methods: (1) the STPA hazard analysis, (2) the EWaSAP early warning sign identification approach, and (3) a dissimilarity measure for calculating the distance between binary sets. In this paper, the RiskSOAP methodology was applied to a robotic system and the findings show that the indicator is an objective measure for the system's capability to provide its agents with SA about its threats and vulnerabilities. Practitioner Summary: This paper suggests a novel methodology for assessing distributed situation awareness (DSA) regarding safety issues. Given that systems consist of specifications and components possible to be mapped, the risk SA provision capability (RiskSOAP) methodology demonstrates the feasibility of measuring to what extent systems' elements contribute to the emergence of DSA.
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Affiliation(s)
| | - Ioannis M Dokas
- a Department of Civil Engineering , Democritus University of Thrace , Xanthi , Greece
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