Human Factors in Healthcare

Natalie Sanford

Olivia Lounsbury

Gabriel Reedy

Dame Anne Marie Rafferty

Janet E Anderson

Team adaptive capacity and adaptation in dynamic environments: A scoping review of the literature

团队适应能力与动态环境中的适应性：文献范围综述

Acute stress is a known contributor to surgical outcomes. While trauma care is widely acknowledged to be stressful, understanding of specific sources of practitioner stress across learner levels is currently limited. Implementing tailored stress mitigation techniques is not possible without an increased understanding of the specific stress triggers. The objective of this study was to explore sources of acute stress for trauma care providers across various learner levels. Semi-structured interviews were undertaken following major trauma activations at a Level 1 urban trauma center. Interviews were conducted with medical students, surgical residents, and surgical attendings, exploring their perception of acute stress during the preceding event. Interviews were transcribed, coded and analyzed for emerging themes. 38 trauma team shifts were observed including major trauma activations. 58 interviews were conducted with 4 medical students, 7 junior residents, 4 senior residents, and 7 trauma surgery attendings. Three predominant themes related to sources of acute stress where identified: "performance", "stress contagion" and "fear of the unknown". While all three themes were identified across all learner levels, emphasis and context for a given theme varied based on an individual's position within the team hierarchy. Three recurring sources of stress identified amongst all learner levels within the trauma team: "performance", "stress contagion" and "fear of the unknown". These themes offer concrete targets for future development of stress mitigation efforts.

Brandon T. Stryder

Erin C. Hall

Annemarie Newark

Jack Sava

Allan Fong

Shimae C. Fitzgibbons

Trauma team on call: Why are we all so stressed?

创伤团队待命：为什么我们都如此紧张？

Pediatric care transitions are important to patient safety, and improved methods to provide feedback about care transitions may lead to improvement. We conducted a secondary analysis of five simulations of the handoff of a pediatric trauma patient from the operating room (OR) to the pediatric intensive care unit (PICU) at a high-fidelity simulation center in the Midwestern United States using practicing clinicians as participants. By synthesizing literature with a qualitative content analysis of the simulation recordings, we identified communication content for these transitions: patient information, anesthesia information, surgical information, nursing information, equipment and technology transfer, patient transfer, professional environment, and simulation. We then used the five simulations to demonstrate use of natural language processing (NLP) models to classify communication content and team cognition behaviors, which could automate real-time evaluation of handoffs. We coded the communication content and behavior of each utterance of the simulations to test and train six support vector machine (SVM) models. Our most frequent communication content codes on average were anesthesia information (19.6 occurrences) followed by surgical information (17.6 occurrences). We found that a SVM model utilizing K-fold stratification with hyperparameter sensitivity analysis best classified communication content and behaviors, with accuracy scores of 74.19% and 54.84%, respectively. We believe our model could be improved through training with a larger dataset from real-life handoffs. Our communication content codes are organized according to what role is likely to provide that information, but handoff protocols must be explicitly team-based to allow team members to share information regardless of role.

Emma Mayes

Jonathan A. Gehlbach

Paul M. Jeziorczak

Abigail R. Wooldridge

Machine learning to operationalize team cognition: A case study of patient handoffs

机器学习在团队认知操作化中的应用：患者交接案例研究

Incidental findings, including masses, anatomic abnormalities, medical conditions, and foreign bodies, are an increasingly common medical phenomenon. We sought to categorize and determine the risk and prevalence of incidental findings in an inpatient setting as well as the appropriateness of follow-up and clinical outcomes. We performed a cross sectional study of 210 patients admitted to the hospital medicine service between January 1, 2018, and May 31, 2018. Incidental findings were identified and categorized into anatomic abnormalities, masses, medical conditions and foreign bodies. They were assigned harm scores ranging from 1 to 5 with 1 representing potential for catastrophic harm and 5 representing no potential for harm. Appropriate follow-up and adverse events were determined. We identified 235 incidental findings of which 179 (76.2%) had a harm score of 4 (20.0%) or 5 (56.2%). 43 (18.3%) incidental findings had a harm score of 3. None had a harm score of 1 and 13 (5.5%) had a harm score of 2. 79 (33.6%) were anatomic abnormalities, 40 (17%) were masses, 115 (48.9%) were medical conditions, and 1 (0.4%) was a foreign body. Of the 13 incidental findings with a harm score 2, only 2 (15.4%) were addressed during the hospital stay or within 2 months of hospitalization. There were 29 studies with a radiologist's recommendation for follow-up, 41.3% of the recommended follow-ups were completed in the suggested timeframe. Five (2.1%) of the incidental findings without recommended follow-up progressed. None resulted in deaths. Incidental findings are common among hospitalized patients undergoing imaging studies. Most incidental findings are low-risk and are not specifically addressed in the discharge plan or in follow-up. The high prevalence of low-risk incidental findings may contribute to limited adverse clinical outcomes for the rare, high-risk incidental findings.

Preetha Nair

Niraj Madhani

Bryan Block

Lindsay Ripley

Maryam Warsi

Anita Hegde

Eugene S. Chu

Prevalence, taxonomy, and outcomes of inpatient imaging incidental findings

住院影像偶然发现的发生率、分类及结果

Cold exposure generally has a negative effect on tasks that rely on finger dexterity. It is not known if cold exposure will affect immediate responder's ability to perform first aid for life-threatening bleedings, specifically tourniquet application. This study investigates the effect of cold exposure on immediate responder's tourniquet application ability and their experienced stress. 29 adult participants completed a tourniquet application test in a baseline condition and three partial cold immersion conditions where their hands were immersed in near 0 °C water. The three conditions lowered the participant's hand-skin temperature to 16 °C, 12 °C and 8 °C, respectively. Tourniquet application was conducted on the leg of a rescue manikin and was measured using a procedural checklist. Time until bleeding control and total application time was also measured. Stress was measured using the Short Stress State Questionnaire. The results show that cold exposure, specifically lowering hand-skin temperature to 8 °C, significantly increases the time to bleeding control (Baseline: M 65.5 s, SD 17.0 s; 8 °C: M 76.9 s, SD 19.6 s) and total application time (Baseline: M 77.1 s, SD 18.0 s; 8 °C: M 89.6 s, SD 21.3 s). No effect was found on application quality in any of the cold exposure conditions. The experience of stress regarding the application of tourniquets in cold conditions showed an increase in task engagement (Normalized change score 0.87, 95% CI [0.55, 1.19]), a decrease in worry (Normalized change score -1.01, 95% CI [-1.35, -0.67]) and no change in distress (Normalized change score -0.02, 95% CI [-0.45, 0.41]). Cold exposure can decrease the chance of survival for the injured person when an immediate responder provides first aid for a massive bleed. Future research should be aimed at finding suitable mitigation strategies for the effect and testing their viability in the presence of additional stressors.

Wilhelm Brodin

Marc Friberg

Carl-Oscar Jonson

Erik Prytz

The effect of cold hands on immediate responder's tourniquet application ability: A within-group trial

冷手对即时响应者止血带应用能力的影响：一项组内试验

Steven Foster

Sudeep Hegde

Ronald Pirrallo

Vishnu Girishan Prabhu

Kevin Taaffe

Michael Ramsay

William Jackson

Identifying Emergency Physicians’ Strategies for Mitigating Workload Transfers during End of Shift Patient Handoffs – A Qualitative Analysis

识别急诊医师在交接班期间减轻工作负荷转移的策略——一项定性分析

A.M. Kooijmans

L. de Rouw

M. van der Elst

J.J. van den Dobbelsteen

Surgical instrument counting: Current practice and staff perspectives on technological support

手术器械计数：当前实践与员工对技术支持的看法

Healthcare-associated infections (HAIs) are common and expensive complications that can occur during inpatient hospital stays. Hand hygiene (HH)—which includes hand washing with soap and water and hand rubbing with alcohol-based hand sanitizer—is the primary tool used by healthcare personnel (HCP) to prevent HAIs. Consequently, the World Health Organization (WHO) proposed guidelines for effective HH in healthcare settings. However, consistent performance of HH by HCP is still lacking. HH in healthcare requires both compliance with indications for HH and quality of HH. Integrative approaches in human factors engineering (HFE) and infection prevention can be used to promote sustainable techniques that can be implemented by HCP to improve the quality of HH techniques. This research proposes a three-phase integrative approach that uses HFE-based methods to identify why HH is often insufficiently executed by HCP in hospital settings and ultimately to help guide HCP to improve HH quality. We performed i) a tabular task analysis (TTA), constructed by HFE personnel and infection prevention specialists, ii) card sorting with infection prevention subject matter experts to prioritize HH steps and analyzed with criticality analysis and subsequent modifications to the TTA, and iii) TTA validation and verification with subject matter experts. Finally, we conducted qualitative interviews with members of hospital leadership and determined that it is feasible to implement the use of TTAs in hospital settings. This research provides enhanced HH guidance using an integrative HFE-based approach and is directed to increase the quality of HH performed by HCP, thereby reducing HAI rates and improving patient safety. Furthermore, these results can be used to support the effective implementation of the WHO's HH guidance. Our findings elucidate some of the challenges to patient safety regarding HH and clarify best practices for HH in hospital settings.

Michael W. Boyce

Trini A. Mathew

Scott C. Roberts

Michael Aniskiewicz

Kathy Krechevsky

Suzanne Dahlberg

Noelle Frye

Jamie E. Trumpler

Leigh V. Evans

Richard A. Martinello

A Human Factors Engineering Approach to Improving Hand Hygiene Quality

一种改进手卫生质量的人因工程学方法

The significance of adaptive performance in today's rapidly evolving work environment cannot be overlooked. Despite its crucial nature, no validated scale exists for assessing adaptive performance in either English or Dutch. This project aims to rectify this deficiency by providing researchers with a reliable and validated instrument to measure adaptive performance. The French scale was translated into English and Dutch using forward and backward translation techniques and was pretested by healthcare professionals. A uniform interpretation of the translations was achieved, and the final questionnaires were distributed to healthcare professionals. We explored the dimensionality of the scales using factor analysis and tested for reliability and validity. Questionnaires were completed by 283 English-speaking and 306 Dutch-speaking respondents. Both questionnaires demonstrated good internal consistency (Cronbach's alpha 0.87) and convergent and discriminant validity. Minor issues were addressed. This analysis presents a dependable and legitimate tool for the further exploration of adaptive performance. The primary focus of this project was on healthcare professionals. Given that the original scale was evaluated across various occupations and the items were worded in general terms, the scale could be applied generally. This project successfully addressed the need for a scale on adaptive performance for researchers conducting studies with English or Dutch respondents.

涉及主题	human factorsergonomicspatient safetydigital healthhealthcare settings
出版信息	出版商: Elsevier Inc.，出版周期: ，期刊类型: journal，开源期刊: 是
基本数据	创刊年份: 2021，原创研究文献占比: ，自引率:， Gold OA占比:
期刊费用	$1750详情
平均审稿周期	22 weeks

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Team adaptive capacity and adaptation in dynamic environments: A scoping review of the literature

Trauma team on call: Why are we all so stressed?

Machine learning to operationalize team cognition: A case study of patient handoffs

Prevalence, taxonomy, and outcomes of inpatient imaging incidental findings

The effect of cold hands on immediate responder's tourniquet application ability: A within-group trial

Team adaptive capacity and adaptation in dynamic environments: A scoping review of the literature

Identifying Emergency Physicians’ Strategies for Mitigating Workload Transfers during End of Shift Patient Handoffs – A Qualitative Analysis

Surgical instrument counting: Current practice and staff perspectives on technological support

A Human Factors Engineering Approach to Improving Hand Hygiene Quality

Adaptive performance scale: Translation and validation in English and Dutch