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Mansour D, Sayeed Z, Padela MT, McCarty S, Tonnos F, Silas D, Mostafa G, Yassir WK. Accountable Operating Room Teams. Orthopedics 2021; 44:e463-e470. [PMID: 34292838 DOI: 10.3928/01477447-20210618-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].
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Factors Predicting Patients’ Willingness to Use Robotic Dental Services. Int J Soc Robot 2021. [DOI: 10.1007/s12369-020-00737-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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3
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Rogers H, Chalil Madathil K, Joseph A, McNeese N, Holmstedt C, Holden R, McElligott JT. Task, usability, and error analyses of ambulance-based telemedicine for stroke care. ACTA ACUST UNITED AC 2021. [DOI: 10.1080/24725579.2021.1883775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hunter Rogers
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Kapil Chalil Madathil
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Anjali Joseph
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Nathan McNeese
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Christine Holmstedt
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Richard Holden
- School of Medicine, Indiana University, Bloomington, IN, USA
| | - James T. McElligott
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Huegli D, Merks S, Schwaninger A. Automation reliability, human-machine system performance, and operator compliance: A study with airport security screeners supported by automated explosives detection systems for cabin baggage screening. APPLIED ERGONOMICS 2020; 86:103094. [PMID: 32342885 DOI: 10.1016/j.apergo.2020.103094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
Using a simulated X-ray screening task, we tested 122 airport security screeners working with the support of explosives detection systems for cabin baggage screening (EDSCB) as low-level automation. EDSCB varied systematically on three automation reliability measures: accuracy, d', and positive predictive value (PPV). Results showed that when unaided performance was high, operator confidence was high, and automation provided only small benefits. When unaided performance was lower, operator confidence was lower, and automation with higher d' provided large benefits. Operator compliance depended on the PPV of automation: We found lower compliance for lower PPV. Automation with a high false alarm rate of 20% and a low PPV of .3 resulted in operators ignoring about one-half of the true automation alarms on difficult targets-a strong cry-wolf effect. Our results suggest that automation reliability described by d' and PPV is more valid than using accuracy alone. When the PPV is below .5, operators should receive clear instructions on how to respond to automation alarms.
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Affiliation(s)
- David Huegli
- University of Applied Sciences and Arts Northwestern Switzerland, School of Applied Psychology, Institute Humans in Complex Systems, Riggenbachstrasse 16, CH-4600, Olten, Switzerland.
| | - Sarah Merks
- University of Applied Sciences and Arts Northwestern Switzerland, School of Applied Psychology, Institute Humans in Complex Systems, Riggenbachstrasse 16, CH-4600, Olten, Switzerland.
| | - Adrian Schwaninger
- University of Applied Sciences and Arts Northwestern Switzerland, School of Applied Psychology, Institute Humans in Complex Systems, Riggenbachstrasse 16, CH-4600, Olten, Switzerland.
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Loh TY, Brito MP, Bose N, Xu J, Tenekedjiev K. Human Error in Autonomous Underwater Vehicle Deployment: A System Dynamics Approach. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:1258-1278. [PMID: 32144834 DOI: 10.1111/risa.13467] [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: 05/22/2018] [Revised: 07/11/2019] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
The use of autonomous underwater vehicles (AUVs) for various applications have grown with maturing technology and improved accessibility. The deployment of AUVs for under-ice marine science research in the Antarctic is one such example. However, a higher risk of AUV loss is present during such endeavors due to the extremities in the Antarctic. A thorough analysis of risks is therefore crucial for formulating effective risk control policies and achieving a lower risk of loss. Existing risk analysis approaches focused predominantly on the technical aspects, as well as identifying static cause and effect relationships in the chain of events leading to AUV loss. Comparatively, the complex interrelationships between risk variables and other aspects of risk such as human errors have received much lesser attention. In this article, a systems-based risk analysis framework facilitated by system dynamics methodology is proposed to overcome existing shortfalls. To demonstrate usefulness of the framework, it is applied on an actual AUV program to examine the occurrence of human error during Antarctic deployment. Simulation of the resultant risk model showed an overall decline in human error incident rate with the increase in experience of the AUV team. Scenario analysis based on the example provided policy recommendations in areas of training, practice runs, recruitment policy, and setting of risk tolerance level. The proposed risk analysis framework is pragmatically useful for risk analysis of future AUV programs to ensure the sustainability of operations, facilitating both better control and monitoring of risk.
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Affiliation(s)
- Tzu Yang Loh
- Australian Maritime College, University of Tasmania, Australia
| | - Mario P Brito
- Centre for Risk Research, Southampton Business School, University of Southampton, United Kingdom
| | - Neil Bose
- Memorial University of Newfoundland, Canada
| | - Jingjing Xu
- Plymouth Business School, University of Plymouth, United Kingdom
| | - Kiril Tenekedjiev
- Australian Maritime College, University of Tasmania, Australia
- Nikola Vaptsarov Naval Academy - Varna, Bulgaria
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Misasi P, Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther Adv Drug Saf 2019; 10:2042098618821916. [PMID: 30728945 PMCID: PMC6351968 DOI: 10.1177/2042098618821916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022] Open
Abstract
Lack of verification is often cited as a root cause of medication errors; however, medication errors occur in spite of conventional verification practices and it appears that human factors engineering (HFE) can inform the design of a more effective method. To this end, an HFE-driven process was designed and implemented in an urban, Midwestern emergency medical service agency. Medication error data were collected over a 54-month period, 27 months before and after implementation. A decrease in the average monthly error rate was realized for all medications administered (49.0%) during the post-intervention time period. The average monthly error rate for fentanyl, a commonly administered analgesic, demonstrated a 71.1% error rate decrease. This study is the first to evaluate the effectiveness of a team-based cross-check process for medication verification to prevent errors in the prehospital setting.
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Affiliation(s)
- Paul Misasi
- Wichita State University, 1845 N. Fairmount, Wichita, KS, 67260, USA
| | - Joseph R Keebler
- Associate Professor, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
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Flohr L, Beaudry S, Johnson KT, West N, Burns CM, Ansermino JM, Dumont GA, Wensley D, Skippen P, Gorges M. Clinician-Driven Design of VitalPAD-An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:3000114. [PMID: 29552425 PMCID: PMC5853765 DOI: 10.1109/jtehm.2018.2812162] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/19/2018] [Accepted: 02/12/2018] [Indexed: 01/22/2023]
Abstract
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.
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Affiliation(s)
- Luisa Flohr
- Faculty of MedicineThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Shaylene Beaudry
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - K Taneille Johnson
- Faculty of MedicineThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Nicholas West
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Catherine M Burns
- Department of Systems Design EngineeringUniversity of WaterlooWaterlooONN2L 3G1Canada
| | - J Mark Ansermino
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada.,BC Children's Hospital Research InstituteVancouverBCV5Z 4H4Canada
| | - Guy A Dumont
- Department of Electrical and Computer EngineeringThe University of British ColumbaVancouverBCV6T 1Z4Canada
| | - David Wensley
- Department of PediatricsThe University of British ColumbaVancouverBCV6H 3V4Canada
| | - Peter Skippen
- Department of PediatricsThe University of British ColumbaVancouverBCV6H 3V4Canada
| | - Matthias Gorges
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada.,BC Children's Hospital Research InstituteVancouverBCV5Z 4H4Canada
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Team interaction during surgery: a systematic review of communication coding schemes. J Surg Res 2015; 195:422-32. [DOI: 10.1016/j.jss.2015.02.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
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Abstract
Mental workload (MWL) is one of the most widely used concepts in ergonomics and human factors and represents a topic of increasing importance. Since modern technology in many working environments imposes ever more cognitive demands upon operators while physical demands diminish, understanding how MWL impinges on performance is increasingly critical. Yet, MWL is also one of the most nebulous concepts, with numerous definitions and dimensions associated with it. Moreover, MWL research has had a tendency to focus on complex, often safety-critical systems (e.g. transport, process control). Here we provide a general overview of the current state of affairs regarding the understanding, measurement and application of MWL in the design of complex systems over the last three decades. We conclude by discussing contemporary challenges for applied research, such as the interaction between cognitive workload and physical workload, and the quantification of workload 'redlines' which specify when operators are approaching or exceeding their performance tolerances.
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Affiliation(s)
- Mark S Young
- a School of Engineering and Design, Brunel University , Uxbridge , UK
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Abstract
In this chapter, we discuss the application of human factors and ergonomics to developing effective simulation training in health care. Simulation provides a safe, effective method for training and assessing human performance. In aviation, simulation-based training and assessment has been widely used, significantly improving safety. This progress would have been impossible without the involvement of human factors and ergonomics. Although aviation and health care have similarities, there also are differences that complicate the widespread implementation of simulation in health care.
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Hignett S, Carayon P, Buckle P, Catchpole K. State of science: human factors and ergonomics in healthcare. ERGONOMICS 2013; 56:1491-503. [PMID: 23926898 DOI: 10.1080/00140139.2013.822932] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
UNLABELLED The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs. PRACTITIONER SUMMARY There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.
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Affiliation(s)
- Sue Hignett
- a Loughborough Design School, Loughborough University , Loughborough Leics LE11 3TU , UK
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Ando T, Tanaka N, Yamada K, Ohno Y. Drip Adjuster: Use of an LED Display to Manually Adjust Intravenous Fluid Infusion Rate. JOURNAL OF ROBOTICS AND MECHATRONICS 2012. [DOI: 10.20965/jrm.2012.p0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Errors in intravenous infusion rates are common at hospitals. A previous study found that actual infusion rates differ significantly from those instructed by doctors. The technique used to adjust the drip rate using a watch is a difficult skill to learn. In this article, we present our recently developed drip adjuster, which makes it easier for a nurse, for example, to adjust the drip rate using an LED display controlled by an Arduino microcontroller. We analyzed a high-speed video of falling infusion drops and imitated dripping by changing the brightness and positioning of light displayed by a row of five LEDs, enabling nurses to easily synchronize LED lighting with the growth and falling of droplets. We then evaluated the accuracy of the drip rate when six nurses used the drip adjuster versus using a watch. We found a significant difference in accuracy between the two methods, with a dramatic increase from 40% accuracy using a watch to 83% accuracy using the drip adjuster in the achievement of an accurate drip rate. The drip adjuster is a simple, effective device that can be used to assist in adjusting the drip rates of intravenous infusions.
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Remembrance of Things Future: Prospective Memory in Laboratory, Workplace, and Everyday Settings. ACTA ACUST UNITED AC 2010. [DOI: 10.1518/155723410x12849346788705] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prospective memory involves remembering—and sometimes forgetting—to perform tasks that must be deferred. This chapter summarizes and provides a perspective on research and theory in this new and rapidly growing field. I explore the limits of existing experimental paradigms, which fail to capture some critical aspects of performance outside of laboratory settings, and review the relatively few studies in workplace and everyday settings. I suggest countermeasures to reduce vulnerability to forgetting to perform deferred tasks, identify roles for human factors practitioners, and propose a research agenda that would extend the current understanding of prospective memory performance.
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Wiegmann DA, Eggman AA, Elbardissi AW, Parker SH, Sundt TM. Improving cardiac surgical care: a work systems approach. APPLIED ERGONOMICS 2010; 41:701-12. [PMID: 20202623 PMCID: PMC2879339 DOI: 10.1016/j.apergo.2009.12.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 09/30/2009] [Indexed: 05/11/2023]
Abstract
Over the past 50 years, significant improvements in cardiac surgical care have been achieved. Nevertheless, surgical errors that significantly impact patient safety continue to occur. In order to further improve surgical outcomes, patient safety programs must focus on rectifying work system factors in the operating room (OR) that negatively impact the delivery of reliable surgical care. The goal of this paper is to provide an integrative review of specific work system factors in the OR that may directly impact surgical care processes, as well as the subsequent recommendations that have been put forth to improve surgical outcomes and patient safety. The important role that surgeons can play in facilitating work system changes in the OR is also discussed. The paper concludes with a discussion of the challenges involved in assessing the impact that interventions have on improving surgical care. Opportunities for future research are also highlighted throughout the paper.
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Affiliation(s)
- Douglas A Wiegmann
- Department of Industrial and Systems Engineering, 1513 University Ave, 3214 Mechanical Engineering Bldg, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Abstract
Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse's work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses' work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.
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