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Segarra GC, Catchpole K, Rayo MF, Hegde S, Jefferies C, Woodward J, Taaffe K. Revealing complex interdependencies in surgical instrument reprocessing using SEIPS 101 tools. APPLIED ERGONOMICS 2024; 119:104307. [PMID: 38735234 PMCID: PMC11194015 DOI: 10.1016/j.apergo.2024.104307] [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: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network, with regular coordination occurring across departmental boundaries. To represent these relationships, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS) 101 Toolkit, which helps model how health-related outcomes are affected by healthcare work systems. Through observations and interviews which built on prior work system analyses, we developed a SEIPS 101 journey map, PETT scan, and tasks matrices to represent the instrument reprocessing work system, revealing complex interdependencies between the people, tools, and tasks occurring within it. The SPD, OR and Courier teams are found to have overlapping responsibilities and a clear co-dependence, with critical implications for the successful functioning of the whole hospital system.
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Affiliation(s)
- Gabriel C Segarra
- Medical University of South Carolina, Charleston, SC, United States.
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, United States
| | | | | | | | - Jeffrey Woodward
- Medical University of South Carolina, Charleston, SC, United States
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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Trbovich PL, Tomasi JN, Kolodzey L, Pinkney SJ, Guerguerian AM, Hubbert J, Kirsch R, Laussen PC. Human Factors Analysis of Latent Safety Threats in a Pediatric Critical Care Unit. Pediatr Crit Care Med 2022; 23:151-159. [PMID: 34593742 DOI: 10.1097/pcc.0000000000002832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify unique latent safety threats spanning routine pediatric critical care activities and categorize them according to their underlying work system factors (i.e., "environment, organization, person, task, tools/technology") and associated clinician behavior (i.e., "legal": expected compliance with or "illegal-normal": deviation from and "illegal-illegal": disregard for standard policies and protocols). DESIGN A prospective observational study with contextual inquiry of clinical activities over a 5-month period. SETTING Two PICUs (i.e., medical-surgical ICU and cardiac ICU) in an urban free-standing quaternary children's hospital. SUBJECTS Attending physicians and trainees, nurse practitioners, registered nurses, respiratory therapists, dieticians, pharmacists, and patient services assistants were observed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Conducted 188 hours of observations to prospectively identify unique latent safety threats. Qualitative observational notes were analyzed by human factors experts using a modified framework analysis methodology to summarize latent safety threats and categorize them based on associated clinical activity, predominant work system factor, and clinician behavior. Two hundred twenty-six unique latent safety threats were observed. The latent safety threats were categorized into 13 clinical activities and attributed to work system factors as follows: "organization" (n = 83; 37%), "task" (n = 52; 23%), "tools/technology" (n = 40; 18%), "person" (n = 32; 14%), and "environment" (n = 19; 8%). Twenty-three percent of latent safety threats were identified when staff complied with policies and protocols (i.e., "legal" behavior) and 77% when staff deviated from policies and protocols (i.e., "illegal-normal" behavior). There was no "illegal-illegal" behavior observed. CONCLUSIONS Latent safety threats span various pediatric critical care activities and are attributable to many underlying work system factors. Latent safety threats are present both when staff comply with and deviate from policies and protocols, suggesting that simply reinforcing compliance with existing policies and protocols, the common default intervention imposed by healthcare organizations, will be insufficient to mitigate safety threats. Rather, interventions must be designed to address the underlying work system threats. This human factors informed framework analysis of observational data is a useful approach to identifying and understanding latent safety threats and can be used in other clinical work systems.
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Affiliation(s)
- Patricia L Trbovich
- HumanEra, Research and Innovation, North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jessica N Tomasi
- HumanEra, Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - Lauren Kolodzey
- HumanEra, Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - Sonia J Pinkney
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anne-Marie Guerguerian
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jackie Hubbert
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Roxanne Kirsch
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter C Laussen
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anaesthesia, Harvard Medical School, Boston, MA
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