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Woo S, Andrieu PC, Abu-Rustum NR, Broach V, Zivanovic O, Sonoda Y, Chi DS, Aviki E, Ellis A, Carayon P, Hricak H, Vargas HA. Bridging Communication Gaps Between Radiologists, Referring Physicians, and Patients Through Standardized Structured Cancer Imaging Reporting: The Experience with Female Pelvic MRI Assessment Using O-RADS and a Simulated Cohort Patient Group. Acad Radiol 2024; 31:1388-1397. [PMID: 37661555 DOI: 10.1016/j.acra.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate whether implementing structured reporting based on Ovarian-Adnexal Reporting and Data System (O-RADS) magnetic resonance imaging (MRI) in women with sonographically indeterminate adnexal masses improves communication between radiologists, referrers, and patients/caregivers and enhances diagnostic performance for determining adnexal malignancy. MATERIALS AND METHODS We retrospectively analyzed prospectively issued MRI reports in 2019-2022 performed for characterizing adnexal masses before and after implementing O-RADS MRI; 56 patients/caregivers and nine gynecologic oncologists ("referrers") were surveyed about report interpretability/clarity/satisfaction; responses for pre- and post-implementation reports were compared using Fisher's exact and Chi-squared tests. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 123 reports from before and 119 reports from after O-RADS MRI implementation were included. Survey response rates were 35.7% (20/56) for patients/caregivers and 66.7% (6/9) for referrers. For patients/caregivers, O-RADS MRI reports were clearer (p < 0.001) and more satisfactory (p < 0.001) than unstructured reports, but interpretability did not differ significantly (p = 0.14), as 28.0% (28/100) of postimplementation and 38.0% (38/100) of preimplementation reports were considered difficult to interpret. For referrers, O-RADS MRI reports were clearer, more satisfactory, and easier to interpret (p < 0.001); only 1.3% (1/77) were considered difficult to interpret. For differentiating benign from malignant adnexal lesions, O-RADS MRI showed area under the curve of 0.92 (95% confidence interval [CI], 0.85-0.99), sensitivity of 0.81 (95% CI, 0.58-0.95), and specificity of 0.91 (95% CI, 0.83-0.96). Diagnostic performance of reports before implementation could not be calculated due to many different phrases used to describe the likelihood of malignancy. CONCLUSION Implementing standardized structured reporting using O-RADS MRI for characterizing adnexal masses improved clarity and satisfaction for patients/caregivers and referrers. Interpretability improved for referrers but remained limited for patients/caregivers.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.); Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.).
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.); Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (O.Z.)
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Emeline Aviki
- Department of Obstetrics and Gynecology, NYU Long Island School of Medicine, Mineola, New York (E.A.)
| | - Annie Ellis
- Patient Family Advisory Council for Quality (PFACQ), Memorial Sloan Kettering Cancer Center, New York, New York (A.E.)
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin (P.C.)
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.)
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Wust KL, Carayon P, Werner NE, Hoonakker PLT, Salwei ME, Rutkowski R, Barton HJ, Dail PVW, King B, Patterson BW, Pulia MS, Shah MN, Smith M. Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care. Hum Factors 2024; 66:701-713. [PMID: 35549738 PMCID: PMC10402098 DOI: 10.1177/00187208221092847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits. BACKGROUND Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care. METHODS Participants included 14 older adult patients (≥ 65 years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient's ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers. RESULTS We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient's health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering. CONCLUSION Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.
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Affiliation(s)
| | | | | | | | - Megan E Salwei
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Salwei ME, Hoonakker P, Carayon P, Wiegmann D, Pulia M, Patterson BW. Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design and Implementation. Hum Factors 2024; 66:647-657. [PMID: 35420923 PMCID: PMC9581441 DOI: 10.1177/00187208221078625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the usability and use of human factors (HF)-based clinical decision support (CDS) implemented in the emergency department (ED). BACKGROUND Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support pulmonary embolism (PE) diagnosis in the ED. We demonstrated high usability of the CDS during scenario-based usability testing. We implemented the HF-based CDS in one ED in December 2018. METHOD We conducted a survey of ED physicians to evaluate the usability and use of the HF-based CDS. We distributed the survey via Qualtrics, a web-based survey platform. We compared the computer system usability questionnaire scores of the CDS between those collected in the usability testing to use of the CDS in the real environment. We asked physicians about their acceptance and use of the CDS, barriers to using the CDS, and areas for improvement. RESULTS Forty-seven physicians (56%) completed the survey. Physicians agreed that diagnosing PE is a major problem and risk scores can support the PE diagnostic process. Usability of the CDS was reported as high, both in the experimental setting and the real clinical setting. However, use of the CDS was low. We identified several barriers to the CDS use in the clinical environment, in particular a lack of workflow integration. CONCLUSION Design of CDS should be a continuous process and focus on the technology's usability in the context of the broad work system and clinician workflow.
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Affiliation(s)
- Megan E. Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Pulia
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian W. Patterson
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Shaffer DW, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Springman S, Gurses AP. Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes. Hum Factors 2024; 66:271-293. [PMID: 35658721 PMCID: PMC11022309 DOI: 10.1177/00187208221086342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.
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Affiliation(s)
- Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin – Madison
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania
| | | | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
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Hose BZ, Carayon P, Hoonakker PLT, Brazelton TB, Dean SM, Eithun BL, Kelly MM, Kohler JE, Ross JC, Rusy DA. Work system barriers and facilitators of a team health information technology. Appl Ergon 2023; 113:104105. [PMID: 37541103 PMCID: PMC10530583 DOI: 10.1016/j.apergo.2023.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
Designing health IT aimed at supporting team-based care and improving patient safety is difficult. This requires a work system (i.e., SEIPS) evaluation of the technology by care team members. This study aimed to identify work system barriers and facilitators to the use of a team health IT that supports care transitions for pediatric trauma patients. We conducted an analysis on 36 interviews - representing 12 roles - collected from a scenario-based evaluation of T3. We identified eight dimensions with both barriers and facilitators in all five work system elements: person (experience), task (task performance, workload/efficiency), technology (usability, specific features of T3), environment (space, location), and organization (communication/coordination). Designing technology that meets every role's needs is challenging; in particular, when trade-offs need to be managed, e.g., additional workload for one role or divergent perspectives regarding specific features. Our results confirm the usefulness of a continuous work system approach to technology design and implementation.
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Affiliation(s)
- Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Peter L T Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | | | - Michelle M Kelly
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Joshua C Ross
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Deborah A Rusy
- American Family Children's Hospital, UW Health, USA; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, USA
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Hoonakker PLT, Carayon P, Brown RL, Schwei R, Green RK, Rabas M, Hoang L, Wust KL, Rutkowski R, Salwei ME, Barton HJ, Shah MN, Pulia MS, Patterson BW, Dail PVW, Krause S, Buckley D, Hankwitz J, Werner NE. Satisfaction of Older Patients With Emergency Department Care: Psychometric Properties and Construct Validity of the Consumer Emergency Care Satisfaction Scale. J Nurs Care Qual 2023; 38:256-263. [PMID: 36827689 PMCID: PMC10205653 DOI: 10.1097/ncq.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved, including the definition, dimension, and scoring of scales. PURPOSE The purpose of this study was to examine the construct validity of the CECSS and make suggestions on how to improve the tool to measure overall satisfaction with ED care. METHODS We administered 2 surveys to older adults who presented with a fall to the ED and used electronic health record data to examine construct validity of the CECSS and ceiling effects. RESULTS Using several criteria, we improved construct validity of the CECSS, reduced ceiling effects, and standardized scoring. CONCLUSION We addressed several methodological issues with the CECSS and provided recommendations for improvement.
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Affiliation(s)
- Peter L T Hoonakker
- Department of Industrial and Systems Engineering (Dr Carayon), Wisconsin Institute for Health System Engineering (WHISE) (Drs Hoonakker and Rutkowski and Mss Wust and Barton), School of Nursing (Dr Brown and Ms Krause), and Department of Emergency Medicine (Mss Buckley and Hankwitz), School of Medicine and Public Health (Mss Schwei, Green, Rabas, and Hoang and Drs Shah, Pulia, and Patterson), University of Wisconsin-Madison (Dr Dail); Center for Research and Innovation in Systems Safety (CRISS), Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center Nashville, Tennessee (Dr Salwei); and Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington (Dr Werner)
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Barton HJ, Salwei ME, Rutkowski RA, Wust K, Krause S, Hoonakker PL, Dail PVW, Buckley DM, Eastman A, Ehlenfeldt B, Patterson BW, Shah MN, King BJ, Werner NE, Carayon P. Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation. JMIR Hum Factors 2023; 10:e43729. [PMID: 36892941 PMCID: PMC10037171 DOI: 10.2196/43729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients-with the potential to prevent adverse outcomes-is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how to manage symptoms, medications, and follow-up care. OBJECTIVE This study aims to assess a multistage method for integrating diverse expertise (ie, clinical, an older adult care partner, and health IT) with human factors engineering (HFE) expertise in the usability evaluation of the patient-facing ED AVS. METHODS We conducted a three-staged heuristic evaluation of an ED AVS using heuristics developed for use in evaluating patient-facing documentation. In stage 1, HFE experts reviewed the AVS to identify usability issues. In stage 2, 6 experts of varying expertise (ie, emergency medicine physicians, ED nurses, geriatricians, transitional care nurses, and an older adult care partner) rated each previously identified usability issue on its potential impact on patient comprehension and patient safety. Finally, in stage 3, an IT expert reviewed each usability issue to identify the likelihood of successfully addressing the issue. RESULTS In stage 1, we identified 60 usability issues that violated a total of 108 heuristics. In stage 2, 18 additional usability issues that violated 27 heuristics were identified by the study experts. Impact ratings ranged from all experts rating the issue as "no impact" to 5 out of 6 experts rating the issue as having a "large negative impact." On average, the older adult care partner representative rated usability issues as being more significant more of the time. In stage 3, 31 usability issues were rated by an IT professional as "impossible to address," 21 as "maybe," and 24 as "can be addressed." CONCLUSIONS Integrating diverse expertise when evaluating usability is important when patient safety is at stake. The non-HFE experts, included in stage 2 of our evaluation, identified 23% (18/78) of all the usability issues and, depending on their expertise, rated those issues as having differing impacts on patient comprehension and safety. Our findings suggest that, to conduct a comprehensive heuristic evaluation, expertise from all the contexts in which the AVS is used must be considered. Combining those findings with ratings from an IT expert, usability issues can be strategically addressed through redesign. Thus, a 3-staged heuristic evaluation method offers a framework for integrating context-specific expertise efficiently, while providing practical insights to guide human-centered design.
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Affiliation(s)
- Hanna J Barton
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Rachel A Rutkowski
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Kathryn Wust
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Sheryl Krause
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter Lt Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Paula vW Dail
- University of Wisconsin-Madison Health Sciences Patient and Family Advisory Council Member, Madison, WI, United States
| | - Denise M Buckley
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, United States
| | - Alexis Eastman
- Center for Aging Research and Education, School of Nursing, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Brad Ehlenfeldt
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, United States
| | - Brian W Patterson
- Berbee Walsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Manish N Shah
- Berbee Walsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Barbara J King
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
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Hose BZ, Carayon P, Hoonakker PLT, Ross JC, Eithun BL, Rusy DA, Kohler JE, Brazelton TB, Dean SM, Kelly MM. Managing multiple perspectives in the collaborative design process of a team health information technology. Appl Ergon 2023; 106:103846. [PMID: 35985249 PMCID: PMC10024924 DOI: 10.1016/j.apergo.2022.103846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
We need to design technologies that support the work of health care teams; designing such solutions should integrate different clinical roles. However, we know little about the actual collaboration that occurs in the design process for a team-based care solution. This study examines how multiple perspectives were managed in the design of a team health IT solution aimed at supporting clinician information needs during pediatric trauma care transitions. We focused our analysis on four co-design sessions that involved multiple clinicians caring for pediatric trauma patients. We analyzed design session transcripts using content analysis and process coding guided by Détienne's (2006) co-design framework. We expanded upon Détienne (2006) three collaborative activities to identify specific themes and processes of collaboration between care team members engaged in the design process. The themes and processes describe how team members collaborated in a team health IT design process that resulted in a highly usable technology.
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Affiliation(s)
- Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Peter L T Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Joshua C Ross
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Deborah A Rusy
- American Family Children's Hospital, UW Health, USA; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Michelle M Kelly
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
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Salwei ME, Carayon P. A Sociotechnical Systems Framework for the Application of Artificial Intelligence in Health Care Delivery. J Cogn Eng Decis Mak 2022; 16:194-206. [PMID: 36704421 PMCID: PMC9873227 DOI: 10.1177/15553434221097357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In the coming years, artificial intelligence (AI) will pervade almost every aspect of the health care delivery system. AI has the potential to improve patient safety (e.g. diagnostic accuracy) as well as reduce the burden on clinicians (e.g. documentation-related workload); however, these benefits are yet to be realized. AI is only one element of a larger sociotechnical system that needs to be considered for effective AI application. In this paper, we describe the current challenges of integrating AI into clinical care and propose a sociotechnical systems (STS) approach for AI design and implementation. We demonstrate the importance of an STS approach through a case study on the design and implementation of a clinical decision support (CDS). In order for AI to reach its potential, the entire work system as well as clinical workflow must be systematically considered throughout the design of AI technology.
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Affiliation(s)
- Megan E. Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI
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10
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Høyland SA, Holte KA, Islam K, Øygaarden O, Kjerstad E, Høyland SA, Waernes HR, Gürgen M, Conde KB, Hovland KS, Rødseth E, Carayon P, Fallon M, Ivins N, Bradbury S, Husebø SIE, Harding KG, Ternowitz T. A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective. Int Wound J 2022; 20:1712-1724. [PMID: 36261052 PMCID: PMC10088836 DOI: 10.1111/iwj.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 11/29/2022] Open
Abstract
Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.
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Affiliation(s)
- Sindre Aske Høyland
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kari Anne Holte
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kamrul Islam
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Olaug Øygaarden
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Egil Kjerstad
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | | | | | - Marcus Gürgen
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Eirin Rødseth
- Department for Personal E-Health, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Pascale Carayon
- Department for Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Nicola Ivins
- Welsh Wound Innovation Centre WWIC, Ynysmaerdy, Wales
| | | | | | - Keith G Harding
- School of Medicine, Cardiff University, Cardiff, UK.,Skin Research Institute of Singapore (SRIS), Novena, Singapore
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
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11
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Hoonakker PLT, Carayon P, Brown RL, Werner NE. A Systematic Review of the Consumer Emergency Care Satisfaction Scale (CECSS). J Nurs Care Qual 2022; 37:349-355. [PMID: 35797636 PMCID: PMC9420772 DOI: 10.1097/ncq.0000000000000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient experience is receiving increasing attention in the context of patient-centered care. However, there are relatively few instruments that measure patient experience that are valid and reliable. OBJECTIVE In this study, we systematically review the literature on the Consumer Emergency Care Satisfaction Scale (CECSS) and examine its psychometric properties. METHODS We conducted a systematic literature search in the Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Web of Science databases on articles that contain information on the CECSS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Our systematic literature search resulted in 28 articles in which the CECSS was used. CONCLUSIONS Results of our literature review show that from a psychometric perspective, the CECSS is a valid and reliable instrument. However, the results of our study also show that the CECSS has several weaknesses. We have made recommendations to improve the CECSS.
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Affiliation(s)
- Peter L T Hoonakker
- Wisconsin Institute for Health System Engineering (WHISE) (Dr Hoonakker), Department of Industrial and Systems Engineering (Drs Carayon and Werner), and School of Nursing, Medicine and Public Health (Dr Brown), University of Wisconsin-Madison
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12
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Carayon P. Implementation or continuous design? The contribution of human factors and engineering to healthcare quality and patient safety. Implement Sci 2022. [DOI: 10.4324/9781003109945-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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13
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Carayon P, Hose BZ, Wooldridge A, Brazelton TB, Dean SM, Eithun BL, Kelly MM, Kohler JE, Ross J, Rusy DA, Hoonakker PLT. Human-centered design of team health IT for pediatric trauma care transitions. Int J Med Inform 2022; 162:104727. [PMID: 35305517 PMCID: PMC9437147 DOI: 10.1016/j.ijmedinf.2022.104727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND As problems of acceptance, usability and workflow integration continue to emerge with health information technologies (IT), it is critical to incorporate human factors and ergonomics (HFE) methods and design principles. Human-centered design (HCD) provides an approach to integrate HFE and produce usable technologies. However, HCD has been rarely used for designing team health IT, even though team-based care is expanding. OBJECTIVE To describe the HCD process used to develop a usable team health IT (T3 or Teamwork Transition Technology) that provides cognitive support to pediatric trauma care teams during transitions from the emergency department to the operating room and the pediatric intensive care unit. METHODS The HCD process included seven steps in three phases of analysis, design activities and feedback. RESULTS The HCD process involved multiple perspectives and clinical roles that were engaged in inter-related activities, leading to design requirements, i.e., goals for the technology, a set of 47 information elements, and a list of HFE design principles applied to T3. Results of the evaluation showed a high usability score for T3. CONCLUSIONS HFE can be integrated in the HCD process through a range of methods and design principles. That design process can produce a usable technology that provides cognitive support to a large diverse team involved in pediatric trauma care transitions. Future research should continue to focus on HFE-based design of team health IT.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States.
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, United States
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, United States
| | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | - Shannon M Dean
- Department of Pediatric Medicine, St Jude's Hospital, United States
| | - Ben L Eithun
- American Family Children's Hospital, UW Health, United States
| | - Michelle M Kelly
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | | | - Joshua Ross
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, United States
| | - Deborah A Rusy
- American Family Children's Hospital, UW Health, United States; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, United States
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States
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14
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Jacobsohn GC, Leaf M, Liao F, Maru AP, Engstrom CJ, Salwei ME, Pankratz GT, Eastman A, Carayon P, Wiegmann DA, Galang JS, Smith MA, Shah MN, Patterson BW. Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments. Healthc (Amst) 2022; 10:100598. [PMID: 34923354 PMCID: PMC8881336 DOI: 10.1016/j.hjdsi.2021.100598] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
Of the 3 million older adults seeking fall-related emergency care each year, nearly one-third visited the Emergency Department (ED) in the previous 6 months. ED providers have a great opportunity to refer patients for fall prevention services at these initial visits, but lack feasible tools for identifying those at highest-risk. Existing fall screening tools have been poorly adopted due to ED staff/provider burden and lack of workflow integration. To address this, we developed an automated clinical decision support (CDS) system for identifying and referring older adult ED patients at risk of future falls. We engaged an interdisciplinary design team (ED providers, health services researchers, information technology/predictive analytics professionals, and outpatient Falls Clinic staff) to collaboratively develop a system that successfully met user requirements and integrated seamlessly into existing ED workflows. Our rapid-cycle development and evaluation process employed a novel combination of human-centered design, implementation science, and patient experience strategies, facilitating simultaneous design of the CDS tool and intervention implementation strategies. This included defining system requirements, systematically identifying and resolving usability problems, assessing barriers and facilitators to implementation (e.g., data accessibility, lack of time, high patient volumes, appointment availability) from multiple vantage points, and refining protocols for communicating with referred patients at discharge. ED physician, nurse, and patient stakeholders were also engaged through online surveys and user testing. Successful CDS design and implementation required integration of multiple new technologies and processes into existing workflows, necessitating interdisciplinary collaboration from the onset. By using this iterative approach, we were able to design and implement an intervention meeting all project goals. Processes used in this Clinical-IT-Research partnership can be applied to other use cases involving automated risk-stratification, CDS development, and EHR-facilitated care coordination.
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Affiliation(s)
- Gwen Costa Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
| | - Margaret Leaf
- Applied Data Science, Enterprise Analytics, UW Health, Madison, WI, USA.
| | - Frank Liao
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA; Applied Data Science, Enterprise Analytics, UW Health, Madison, WI, USA.
| | - Apoorva P. Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Collin J. Engstrom
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA,Department of Computer Science, Winona State University, Rochester, MN, USA
| | - Megan E. Salwei
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin, USA,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, USA,Center for Research and Innovation in Systems Safety, Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald T Pankratz
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Alexis Eastman
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI, USA; Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, USA.
| | - Douglas A. Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin, USA,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joel S. Galang
- Applied Data Science, Enterprise Analytics, UW Health, Madison, Wisconsin, USA
| | - Maureen A. Smith
- Health Innovation Program, University of Wisconsin-Madison, Madison, Wisconsin, USA,Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Manish N. Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA,Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA,Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brian W. Patterson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA,Health Innovation Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
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15
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Carayon P, Thuemling T, Parmasad V, Bao S, O'Horo J, Bennett NT, Safdar N. Implementation of An Antibiotic Stewardship Intervention to Reduce Prescription of Fluoroquinolones: A Human Factors Analysis in Two Intensive Care Units. J Patient Saf Risk Manag 2022; 26:161-171. [PMID: 35146329 DOI: 10.1177/25160435211025417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such as Clostridioides difficile (CDI); this is particularly important for fluoroquinolones (FQ), which are frequently used in critical care settings. In this study, using a multiple case study research approach, we conduct an in-depth analysis of an intervention aimed at limiting ICU prescriber access to FQ in two ICUs of two hospitals. The data collection and analysis were guided by a human factors engineering approach based on the SEIPS (Systems Engineering Initiative for Patient Safety) model and evidence-based implementation principles. Our results show some differences in the implementation of the FQ intervention between the two ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped to quickly identify problems with the intervention and ensure that changes were made in a just-in-time manner (e.g. just-in-time training, removal of FQ in order set for pneumonia). Despite their organizational differences, both sites developed strategies to successfully implement the FQ intervention.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison
| | - Teresa Thuemling
- Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison
| | | | - Songtao Bao
- School of Journalism and Mass Communication; University of Wisconsin-Madison
| | | | | | - Nasia Safdar
- Department of Medicine; University of Wisconsin-Madison
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16
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Schroeer K, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Dean S, Springman S, Rahal R, Gurses AP. Care transition of trauma patients: Processes with articulation work before and after handoff. Appl Ergon 2022; 98:103606. [PMID: 34638036 PMCID: PMC10373374 DOI: 10.1016/j.apergo.2021.103606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA
| | - Katherine Schroeer
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Michelle M Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rima Rahal
- Vituity, Mercy General Hospital and Sutter Medical Center, Sacramento, CA, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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17
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Hoonakker PLT, Hose BZ, Carayon P, Eithun BL, Rusy DA, Ross JC, Kohler JE, Dean SM, Brazelton TB, Kelly MM. Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions. Appl Clin Inform 2022; 13:218-229. [PMID: 35139563 PMCID: PMC8828456 DOI: 10.1055/s-0042-1742368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/21/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of children's death. Trauma care by its very nature is team based but due to the emergent nature of trauma, critical clinical information is often missed in the transition of these patients from one service or unit to another. Teamwork transition technology can help support these transitions and minimize information loss while enhancing information gathering and storage. In this study, we created a large screen technology to support shared situational awareness across multiple clinical roles and departments. OBJECTIVES This study aimed to examine if the Teamwork Transition Technology (T3) supports teams and team cognition. METHODS We used a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T3. RESULTS Results of the evaluation show that most participants agreed that the technology helps achieve the goals set out in the design phase. Respondents thought that T3 organizes and presents information in a different way that was helpful to them. CONCLUSION In this study, we examined a health IT (T3) that was designed to support teams and team cognition. The results of our evaluation show that participants agreed that T3 does support them in their work and increases their situation awareness.
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Affiliation(s)
- Peter L. T. Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States
| | - Pascale Carayon
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ben L. Eithun
- American Family Children's Hospital, Madison, Wisconsin, United States
| | - Deborah A. Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Joshua C. Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Jonathan E. Kohler
- Department of Surgery, UC Davis Children's Hospital, Sacramento, California, United States
| | - Shannon M. Dean
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Tom B. Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
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18
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Salwei ME, Carayon P, Wiegmann D, Pulia MS, Patterson BW, Hoonakker PLT. Usability barriers and facilitators of a human factors engineering-based clinical decision support technology for diagnosing pulmonary embolism. Int J Med Inform 2021; 158:104657. [PMID: 34915320 PMCID: PMC9177900 DOI: 10.1016/j.ijmedinf.2021.104657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health IT, such as clinical decision support (CDS), has the potential to improve patient safety. However, poor usability of health IT continues to be a major concern. Human factors engineering (HFE) approaches are recommended to improve the usability of health IT. Limited evidence exists on the actual impact of HFE methods and principles on the usability of health IT. OBJECTIVE To identify and describe the usability barriers and facilitators of an HFE-based CDS prior to implementation in the emergency department (ED). METHODS We conducted debrief interviews with 32 emergency medicine physicians as a part of a scenario-based simulation study evaluating the usability of the HFE-based CDS. We performed a deductive content analysis of the interviews using the usability criteria of Scapin and Bastien as a framework. RESULTS We identified 271 occurrences of usability barriers (94) and facilitators (177) of the HFE-based CDS. For instance, we found a facilitator relating to the usability criteria prompting as the PE Dx helps the physician order diagnostic tests following the risk assessment. We found the most facilitators relating to the criteria, minimal actions, e.g. as the PE Dx automatically populates vitals signs (e.g., heart rate) from the chart into the CDS. The majority of the usability barriers related to the usability criteria, compatibility (i.e., workflow integration), which was not explicitly considered in the HFE design of the CDS. For example, the CDS did not support resident and attending physician teamwork in the PE diagnostic process. CONCLUSION The systematic use of HFE principles in the design of CDS improves the usability of these technologies. In order to further reduce usability barriers, workflow integration should be explicitly considered in the design of health IT.
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Affiliation(s)
- Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Michael S Pulia
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Brian W Patterson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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19
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Yanke E, Moriarty H, Carayon P, Safdar N. "The Invisible Staff": A Qualitative Analysis of Environmental Service Workers' Perceptions of the VA Clostridium difficile Prevention Bundle Using a Human Factors Engineering Approach. J Patient Saf 2021; 17:e806-e814. [PMID: 29894437 PMCID: PMC6800805 DOI: 10.1097/pts.0000000000000500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers' (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle. METHODS A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework. RESULTS Environmental service workers reported adequate cleaning supplies/equipment and displayed excellent knowledge of CDI hand hygiene requirements. Environmental service workers described current supervisory practices as providing an acceptable amount of time to clean CDI rooms, although other healthcare workers often pressured ESWs to clean rooms more quickly. Environmental service workers reported significant concern for CDI patients' family members as well as suggesting uncertainty regarding the need for family members to follow infection prevention practices. Small and cluttered patient rooms made cleaning tasks more difficult, and ESW cleaning tasks were often interrupted by other healthcare workers. Environmental service workers did not feel comfortable asking physicians for more time to finish cleaning a room nor did ESWs feel comfortable pointing out lapses in physician hand hygiene. CONCLUSIONS Multiple work system components serve as barriers to and facilitators of ESW adherence to the nationally mandated Department of Veterans Affairs CDI bundle. Environmental service workers may represent an underappreciated resource for hospital infection prevention, and further efforts should be made to engage ESWs as members of the health care team.
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Affiliation(s)
- Eric Yanke
- Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Helene Moriarty
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital and Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School and Infection Control Department, University of Wisconsin-Madison, Madison, Wisconsin
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20
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Salwei ME, Carayon P, Hoonakker PLT, Hundt AS, Wiegmann D, Pulia M, Patterson BW. Workflow integration analysis of a human factors-based clinical decision support in the emergency department. Appl Ergon 2021; 97:103498. [PMID: 34182430 PMCID: PMC8474147 DOI: 10.1016/j.apergo.2021.103498] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 05/27/2023]
Abstract
Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. We propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, we identify 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED. Using data on these 134 barriers and facilitators, we distinguish 25 components of workflow integration of the CDS, which are described according to four dimensions of workflow integration: time, flow, scope of patient journey, and level. The proposed definition and conceptual model of workflow integration can be used to inform health IT design; this is the purpose of the proposed checklist that can help to ensure consideration of workflow integration during the development of health IT.
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Affiliation(s)
- Megan E Salwei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, USA; Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Ann Schoofs Hundt
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Michael Pulia
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, USA
| | - Brian W Patterson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, USA
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21
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Werner NE, Rutkowski RA, Krause S, Barton HJ, Wust K, Hoonakker P, King B, Shah MN, Pulia MS, Brenny-Fitzpatrick M, Smith M, Carayon P. Disparate perspectives: Exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility. Appl Ergon 2021; 96:103509. [PMID: 34157478 PMCID: PMC8320066 DOI: 10.1016/j.apergo.2021.103509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/28/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. We explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF). We conducted a thematic analysis of interviews with ED and SNF healthcare professionals and identified three themes: 1) ED and SNF healthcare professionals had misaligned mental models regarding communication processes and tools used during care transitions, 2) ED and SNF healthcare professionals had misaligned mental models regarding healthcare system capability, and 3) Misalignments led to individual and organizational consequences. Overall, we found that SNF and ED healthcare professionals are part of the same process but have different perceptions of the process. Future work must take steps to redesign and realign these distinct work systems such that those involved conceptualize themselves as part of a joint process.
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Affiliation(s)
- Nicole E Werner
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States.
| | - Rachel A Rutkowski
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Sheryl Krause
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Hanna J Barton
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Kathryn Wust
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Peter Hoonakker
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Barbara King
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Manish N Shah
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Michael S Pulia
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Maria Brenny-Fitzpatrick
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Maureen Smith
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Pascale Carayon
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
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22
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Abstract
Industry 4.0 has transformed manufacturing industry into a new paradigm. In a manner similar to manufacturing, health care delivery is at the dawn of a foundational change into the new era of smart and connected health care, referred to as Health Care 4.0. In this paper, we discuss the historical evolution of Health Care 1.0 to 4.0, describe the characteristics of smart and connected care in Health Care 4.0, identify multiple research challenges and opportunities of Health Care 4.0 in terms of data, model, dynamics, and integration, and outline the implications of people, process, system and health outcomes. Finally, conclusions and recommendations are presented in the areas of (1) involvement of multiple disciplines and perspectives, (2) development of technologies and methodologies with combination of quantitative and qualitative approaches, (3) closed-loop integration of sociotechnical system, and (4) design of person-centered system with specific attention to human needs and health equity.
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Affiliation(s)
- Jingshan Li
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
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23
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Carayon P, Salwei ME. Moving toward a sociotechnical systems approach to continuous health information technology design: the path forward for improving electronic health record usability and reducing clinician burnout. J Am Med Inform Assoc 2021; 28:1026-1028. [PMID: 33537756 DOI: 10.1093/jamia/ocab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Based on our analysis of descriptions provided by four EHR vendors on their EHR usability efforts, we provide three recommendations aimed at improving the usability of health information technology and reducing clinician burnout. First, EHR vendors need to dedicate increased attention to the design of the entire sociotechnical (work) system, including the EHR technology and its usability as well as the interactions of the technology with other system elements. Second, EHR vendors need to deepen and broaden their understanding of the work of clinicians and care teams by using diverse and mixed method. Third, in collaboration with health care organizations, EHR vendors should engage in cycles of continuous design and learning in order to improve the usability of health IT.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Megan E Salwei
- Department of Biomedical Informatics, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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24
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Parmasad V, Keating JA, Carayon P, Safdar N. Physical distancing for care delivery in health care settings: Considerations and consequences. Am J Infect Control 2021; 49:1085-1088. [PMID: 33359551 PMCID: PMC7759337 DOI: 10.1016/j.ajic.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
As health care systems explore new ways of delivering care for patients with and without COVID-19, they must consider how to maintain physical distancing among health care workers and patients. Physical distancing in high complexity systems such as health care is particularly challenging and may benefit from a human factors and systems engineering perspective. We discuss challenges to implementing and maintaining physical distancing in health care settings and present possible solutions from a human factors and systems engineering perspective.
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Affiliation(s)
- Vishala Parmasad
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Julie A Keating
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI; Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
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25
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Carayon P, Wetterneck TB, Cartmill R, Blosky MA, Brown R, Hoonakker P, Kim R, Kukreja S, Johnson M, Paris BL, Wood KE, Walker JM. Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations. J Patient Saf 2021; 17:e429-e439. [PMID: 28248749 PMCID: PMC5573668 DOI: 10.1097/pts.0000000000000358] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs). METHODS Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm). RESULTS We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13-0, P < 0.001), dispensing (0.49-0.16, P < 0.001), and administration (0.83-0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation. CONCLUSIONS Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.
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Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of
Wisconsin-Madison
| | - Tosha B. Wetterneck
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of
Wisconsin-Madison
- Department of Medicine, University of Wisconsin School of Medicine
and Public Health
| | - Randi Cartmill
- Department of Surgery, University of Wisconsin School of Medicine
and Public Health
| | | | - Roger Brown
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
- University of Wisconsin School of Nursing
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of
Wisconsin-Madison
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26
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Zhu W, DeLonay A, Smith M, Carayon P, Li J. Reducing Fall-related Revisits for Elderly Diabetes Patients in Emergency Departments: A Transition Flow Model. IEEE Robot Autom Lett 2021; 6:5642-5649. [PMID: 34179457 PMCID: PMC8224474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This paper introduces a transition flow model to study fall-related emergency department (ED) revisits for elderly patients with diabetes. Five diabetes classes are used to classify patients at discharge, within 7-day revisits, and between 8 and 30-day revisits. Analytical formulas to evaluate patient revisiting risks are derived. To reduce revisits, sensitivity analysis is introduced to identify the most critical, i.e., dominant, factors whose changes can lead to the largest reduction in revisits. In addition, a case study at University of Wisconsin (UW) Hospital ED is described to illustrate the applicability of the model.
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Affiliation(s)
- Wenjun Zhu
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Allie DeLonay
- Department of Population Health Sciences, University of Wisconsin, Madison, WI 53705 USA
| | - Maureen Smith
- Departments of Population Health Sciences and Family Medicine & Community Health, University of Wisconsin, Madison, WI 53705 USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Jingshan Li
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
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27
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Zhu W, DeLonay A, Smith M, Carayon P, Li J. Reducing Fall-Related Revisits for Elderly Diabetes Patients in Emergency Departments: A Transition Flow Model. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3082115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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28
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Safdar N, Parmasad V, Brown R, Carayon P, Lepak A, O'Horo JC, Schulz L. Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol. BMJ Open 2021; 11:e046480. [PMID: 34187821 PMCID: PMC8245435 DOI: 10.1136/bmjopen-2020-046480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the USA, having high incidence in intensive care units (ICU). Antibiotic use increases risk of CDI, with fluoroquinolones (FQs) particularly implicated. In healthcare settings, antibiotic stewardship (AS) and infection control interventions are effective in CDI control, but there is little evidence regarding the most effective AS interventions. Preprescription authorisation (PPA) restricting FQs is a potentially promising AS intervention to reduce CDI. The FQ Restriction for the Prevention of CDI (FIRST) trial will evaluate the effectiveness of an FQ PPA intervention in reducing CDI rates in adult ICUs compared with preintervention care, and evaluate implementation effectiveness using a human-factors and systems engineering model. METHODS AND ANALYSIS This is a multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial. The trial will take place in 12 adult medical-surgical ICUs with ≥10 beds, using Epic as electronic health record (EHR) and pre-existing AS programmes. Sites will receive facilitated implementation support over the 15-month trial period, succeeded by 9 months of follow-up. The intervention comprises a clinical decision support system for FQ PPA, integrated into the site EHRs. Each ICU will be considered a single site and all ICU admissions included in the analysis. Clinical data will be extracted from EHRs throughout the trial and compared with the corresponding pretrial period, which will constitute the baseline for statistical analysis. Outcomes will include ICU-onset CDI rates, FQ days of therapy (DOT), alternative antibiotic DOT, average length of stay and hospital mortality. The study team will also collect implementation data to assess implementation effectiveness using the Systems Engineering Initiative for Patient Safety model. ETHICS AND DISSEMINATION The trial was approved by the Institutional Review Board at the University of Wisconsin-Madison (2018-0852-CP015). Results will be made available to participating sites, funders, infectious disease societies, critical care societies and other researchers. TRIAL REGISTRATION NUMBER NCT03848689.
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Affiliation(s)
- Nasia Safdar
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vishala Parmasad
- Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison Graduate School, Madison, Wisconsin, USA
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexander Lepak
- Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Lucas Schulz
- Pharmacy, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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29
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Knobloch MJ, Musuuza JS, McKinley L, Zimbric ML, Baubie K, Hundt AS, Carayon P, Hagle M, Pfeiffer CD, Galea MD, Crnich CJ, Safdar N. Implementing daily chlorhexidine gluconate (CHG) bathing in VA settings: The human factors engineering to prevent resistant organisms (HERO) project. Am J Infect Control 2021; 49:775-783. [PMID: 33359552 DOI: 10.1016/j.ajic.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Daily use of chlorhexidine gluconate (CHG) has been shown to reduce risk of healthcare-associated infections. We aimed to assess moving CHG bathing into routine practice using a human factors approach. We evaluated implementation in non-intensive care unit (ICU) settings in the Veterans Health Administration. METHODS Our multiple case study approach included non-ICU units from 4 Veterans Health Administration settings. Guided by the Systems Engineering Initiative for Patient Safety, we conducted focus groups and interviews to capture barriers and facilitators to daily CHG bathing. We measured compliance using observations and skin CHG concentrations. RESULTS Barriers to daily CHG include time, concern of increasing antibiotic resistance, workflow and product concerns. Facilitators include engagement of champions and unit shared responsibility. We found shortfalls in patient education, hand hygiene and CHG use on tubes and drains. CHG skin concentration levels were highest among patients from spinal cord injury units. These units applied antiseptic using 2% CHG impregnated wipes vs 4% CHG solution/soap. DISCUSSION Non-ICUs implementing CHG bathing must consider human factors and work system barriers to ensure uptake and sustained practice change. CONCLUSIONS Well-planned rollouts and a unit culture promoting shared responsibility are key to compliance with daily CHG bathing. Successful implementation requires attention to staff education and measurement of compliance.
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30
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Affiliation(s)
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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31
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Valdez RS, Holden RJ, Rivera AJ, Ho CH, Madray CR, Bae J, Wetterneck TB, Beasley JW, Carayon P. Remembering Ben-Tzion Karsh's scholarship, impact, and legacy. Appl Ergon 2021; 92:103308. [PMID: 33253977 DOI: 10.1016/j.apergo.2020.103308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
Dr. Ben-Tzion (Bentzi) Karsh was a mentor, collaborator, colleague, and friend who profoundly impacted the fields of human factors and ergonomics (HFE), medical informatics, patient safety, and primary care, among others. In this paper we honor his contributions by reflecting on his scholarship, impact, and legacy in three ways: first, through an updated simplified bibliometric analysis in 2020, highlighting the breadth of his scholarly impact from the perspective of the number and types of communities and collaborators with which and whom he engaged; second, through targeted reflections on the history and impact of Dr. Karsh's most cited works, commenting on the particular ways they impacted our academic community; and lastly, through quotes from collaborators and mentees, illustrating Dr. Karsh's long-lasting impact on his contemporaries and students.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, VA, USA; Department of Engineering Systems and Environment, University of Virginia, VA, USA.
| | - Richard J Holden
- Department of Medicine, Indiana University, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute Inc, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, IN, USA
| | - A Joy Rivera
- Department of Patient Safety, Froedtert Hospital, WI, USA.
| | - Chi H Ho
- Department of Public Health Sciences, University of Virginia, VA, USA.
| | - Cristalle R Madray
- Department of Community Development and Planning, University of Maryland Medical System, MD, USA.
| | - Jiwoon Bae
- Department of Public Health Sciences, University of Virginia, VA, USA.
| | - Tosha B Wetterneck
- Department of Family Medicine and Community Health, University of Wisconsin, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA.
| | - John W Beasley
- Department of Family Medicine and Community Health, University of Wisconsin, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA; Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, WI, USA.
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32
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Rutkowski RA, Salwei M, Barton H, Wust K, Hoonakker P, Brenny-Fitzpatrick M, King B, Shah MN, Pulia MS, Patterson BW, Dáil PVW, Smith M, Carayon P, Werner NE. Physician Perceptions of Disposition Decision-making for Older Adults in the Emergency Department: A Preliminary Analysis. ACTA ACUST UNITED AC 2021; 64:648-652. [PMID: 34234398 DOI: 10.1177/1071181320641148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disposition decision-making in the emergency department (ED) is critical to patient safety and quality of care. Disposition decision-making has particularly important implications for older adults who comprise a significant portion of ED visits annually and are vulnerable to suboptimal outcomes throughout ED care transitions. We conducted a secondary inductive content analysis of interviews with ED physicians (N= 11) to explore their perceptions of who they involve in disposition decision-making and what information they use to make disposition decisions for older adults. ED physicians cited 7 roles (5 types of clinicians, patients and families) and 11 information types, both clinical (e.g. test/lab results) and non-clinical (e.g. family's preference). Our preliminary findings represent a key first step toward the development of interventions that promote patient safety and quality of care for older adults in the ED by supporting the cognitive and communicative aspects of disposition decision-making.
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Affiliation(s)
- Rachel A Rutkowski
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Megan Salwei
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Hanna Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Kathryn Wust
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Peter Hoonakker
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | | | - Barbara King
- School of Nursing, University of Wisconsin-Madison
| | - Manish N Shah
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison
| | - Michael S Pulia
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison
| | - Brian W Patterson
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison
| | - Paula vW Dáil
- University of Wisconsin-Madison Health Sciences Patient and Family Advisory Council member
| | - Maureen Smith
- University of Wisconsin-Madison School of Medicine and Public Health, Departments of Population Health Sciences and Family Medicine & Community Health.,University of Wisconsin Institute of Clinical and Translational Research Health Innovation Program
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
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33
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Carayon P, Perry S. Human factors and ergonomics systems approach to the COVID-19 healthcare crisis. Int J Qual Health Care 2021; 33:1-3. [PMID: 33432980 PMCID: PMC7543421 DOI: 10.1093/intqhc/mzaa109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/20/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
A human factors and ergonomics (HFE) systems approach offers a model for adjusting work systems and care processes in response to a healthcare crisis such as COVID-19. Using the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, we describe various work system barriers and facilitators experienced by healthcare workers during the COVID-19 crisis. We propose a set of five principles based on this HFE systems approach related to novel pandemic: (i) deferring to local expertise, (ii) facilitating adaptive behaviors, (iii) enhancing interactions between system elements and levels along the patient journey, (iv) re-purposing existing processes and (v) encouraging dynamic continuous learning.
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Affiliation(s)
- Pascale Carayon
- Leon and Elizabeth Janssen Professor in the College of Engineering, Department of Industrial & Systems Engineering, Director of the Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53705, USA
| | - Shawna Perry
- Associate Professor, Emergency Medicine, University of Florida Honorary Researcher, Center for Quality and Productivity Improvement (CPQI), College of Engineering, University of Wisconsin-Madison College of Medicine-Jacksonville, 655 8th St W, Jacksonville, FL 32209, USA
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34
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Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Pascale Carayon
- Department of Industrial & Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
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35
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Zhu W, Patterson BW, Smith M, Rifleman AC, Carayon P, Li J. A Markov Chain Model for Transient Analysis of Handoff Process in Emergency Departments. IEEE Robot Autom Lett 2020; 5:4360-4367. [PMID: 32695881 DOI: 10.1109/lra.2020.2996066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transfer of care between multiple units or facilities is of significant importance for patient safety, care quality, and operation efficiency. Such transfers are often referred to as handoffs in hospitals, which need to be carried out timely, safely, and smoothly with accurate information. This paper introduces a Markov chain model to study the transients of handoff process in hospital emergency departments. The handoff process is modeled by a stochastic process with unavailability of service, which characterizes the constraints in bed capacity, staff shortage, and coordination issues, etc. For systems only allowing one transfer request waiting, the transient performance is obtained through Laplace transform and its inverse transform. Such a result is then used as a building block to study the systems allowing multiple requests waiting through an iteration process, which can reduce the computation complexity substantially. Numerical studies show that such a method can provide estimates of transient performance in the handoff process with acceptable accuracy.
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Affiliation(s)
- Wenjun Zhu
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Brian W Patterson
- Department of Medicine, University of Wisconsin, Madison, WI 53705 USA
| | - Maureen Smith
- Departments of Population Health Sciences and Family Medicine & Community Health, University of Wisconsin, Madison, WI 53705 USA
| | - Anne C Rifleman
- University of Wisconsin Hospital and Clinic, Madison, WI 53705 USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Jingshan Li
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Eithun B, Brazelton T, Ross J, Kohler JE, Kelly MM, Dean SM, Rusy D, Gurses AP. Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. Appl Ergon 2020; 85:103059. [PMID: 32174347 PMCID: PMC7309517 DOI: 10.1016/j.apergo.2020.103059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/13/2019] [Accepted: 01/13/2020] [Indexed: 06/02/2023]
Abstract
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU. We applied the Systems Engineering Initiative for Patient Safety (SEIPS) process modeling method and identified nine dimensions of barriers and facilitators - anticipation, ED decision making, interacting with family, physical environment, role ambiguity, staffing/resources, team cognition, technology and characteristic of trauma care. For example, handoffs involving all healthcare professionals in the OR to PICU transition created a shared understanding of the patient, but sometimes included distractions. Understanding barriers and facilitators can guide future improvements, e.g., designing a team display to support team cognition of healthcare professionals in the care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michelle M Kelly
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA; Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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Carayon P, Cassel C, Dzau VJ. Clinician Burnout and Professional Well-being-Reply. JAMA 2020; 323:1318. [PMID: 32259226 DOI: 10.1001/jama.2020.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison
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Carayon P, Wooldridge A, Hoonakker P, Hundt AS, Kelly MM. SEIPS 3.0: Human-centered design of the patient journey for patient safety. Appl Ergon 2020; 84:103033. [PMID: 31987516 PMCID: PMC7152782 DOI: 10.1016/j.apergo.2019.103033] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 12/08/2019] [Accepted: 12/13/2019] [Indexed: 05/09/2023]
Abstract
The Systems Engineering Initiative for Patient Safety (SEIPS) and SEIPS 2.0 models provide a framework for integrating Human Factors and Ergonomics (HFE) in health care quality and patient safety improvement. As care becomes increasingly distributed over space and time, the "process" component of the SEIPS model needs to evolve and represent this additional complexity. In this paper, we review different ways that the process component of the SEIPS models have been described and applied. We then propose the SEIPS 3.0 model, which expands the process component, using the concept of the patient journey to describe the spatio-temporal distribution of patients' interactions with multiple care settings over time. This new SEIPS 3.0 sociotechnical systems approach to the patient journey and patient safety poses several conceptual and methodological challenges to HFE researchers and professionals, including the need to consider multiple perspectives, issues with genuine participation, and HFE work at the boundaries.
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Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States.
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, United States
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States
| | - Michelle M Kelly
- Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
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Carayon P, Hoonakker P, Hundt AS, Salwei M, Wiegmann D, Brown RL, Kleinschmidt P, Novak C, Pulia M, Wang Y, Wirkus E, Patterson B. Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study. BMJ Qual Saf 2020; 29:329-340. [PMID: 31776197 PMCID: PMC7490974 DOI: 10.1136/bmjqs-2019-009857] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/11/2019] [Accepted: 11/05/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In this study, we used human factors (HF) methods and principles to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. We hypothesised that the application of HF methods and principles will produce a more usable CDS that improves PE diagnostic decision-making, in particular decision about appropriate clinical pathway. MATERIALS AND METHODS We conducted a scenario-based simulation study to compare a HF-based CDS (the so-called CDS for PE diagnosis (PE-Dx CDS)) with a web-based CDS (MDCalc); 32 emergency physicians performed various tasks using both CDS. PE-Dx integrated HF design principles such as automating information acquisition and analysis, and minimising workload. We assessed all three dimensions of usability using both objective and subjective measures: effectiveness (eg, appropriate decision regarding the PE diagnostic pathway), efficiency (eg, time spent, perceived workload) and satisfaction (perceived usability of CDS). RESULTS Emergency physicians made more appropriate diagnostic decisions (94% with PE-Dx; 84% with web-based CDS; p<0.01) and performed experimental tasks faster with the PE-Dx CDS (on average 96 s per scenario with PE-Dx; 117 s with web-based CDS; p<0.001). They also reported lower workload (p<0.001) and higher satisfaction (p<0.001) with PE-Dx. CONCLUSIONS This simulation study shows that HF methods and principles can improve usability of CDS and diagnostic decision-making. Aspects of the HF-based CDS that provided cognitive support to emergency physicians and improved diagnostic performance included automation of information acquisition (eg, auto-populating risk scoring algorithms), minimisation of workload and support of decision selection (eg, recommending a clinical pathway). These HF design principles can be applied to the design of other CDS technologies to improve diagnostic safety.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Megan Salwei
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Peter Kleinschmidt
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Michael Pulia
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yudi Wang
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Emily Wirkus
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brian Patterson
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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40
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Affiliation(s)
- Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, College of Engineering, University of Wisconsin, Madison
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Salwei ME, Carayon P, Hoonakker P, Hundt AS, Novak C, Wang Y, Wiegmann D, Patterson B. Assessing workflow of emergency physicians in the use of clinical decision support. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/1071181319631334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The emergency department (ED) is a complex environment where diagnoses must often be made quickly, based on incomplete information. Pulmonary embolism (PE) is an especially challenging diagnosis that is frequently delayed or missed due to its non-specific symptoms, and can be life-threatening when not treated. Clinical decision supports (CDS) have the potential to improve these difficult decisions; however, previous efforts to implement CDS in the ED have faced challenges due to poor usability and lack of workflow integration. The objective of this study is to identify potential barriers to workflow integration from the technology’s implementation and inform the CDS design; this is achieved by analyzing ED physicians’ workflow during a usability evaluation of two different CDS, a web-based risk scoring CDS and a CDS designed using an human-centered design (HCD) process and human factors (HF) design principles. The number of cases matching the guideline-based workflow and the percent of correct diagnostic decisions increased from the use of the HF-based CDS, but varied depending on the patient scenario. We identified three workflow variations, which had both positive and negative implications for the CDS design and implementation. The workflow analysis can be used to inform the CDS design and improve the technology’s usability and integration in physician workflow prior to implementation.
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Affiliation(s)
- Megan E. Salwei
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | | | - Yudi Wang
- School of Medicine and Public Health, University of Wisconsin-Madison
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Brian Patterson
- UW Health
- School of Medicine and Public Health, University of Wisconsin-Madison
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Kianfar S, Carayon P, Hundt AS, Hoonakker P. Care coordination for chronically ill patients: Identifying coordination activities and interdependencies. Appl Ergon 2019; 80:9-16. [PMID: 31280815 PMCID: PMC8610785 DOI: 10.1016/j.apergo.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/25/2019] [Accepted: 05/03/2019] [Indexed: 05/24/2023]
Abstract
Care coordination is important for chronically ill patients who need assistance from a variety of healthcare professionals especially when they transition through different care settings. There has not been a clear definition of care coordination and its associated activities. This paper provides a two-dimension framework of care coordination for chronically ill patients: 1) coordination activities (i.e. communication and monitoring) and 2) interdependencies (i.e. flow, shared resources, simultaneity). We used this framework in a qualitative content analysis of 12 interviews with healthcare professionals involved in coordinating care of chronically ill patients. We identified a total of 258 care coordination activities and developed categories and sub-categories using the constant comparative method. The first category of care coordination activities involves communication with flow or shared resources interdependencies or both. This category includes arranging services and equipment for the patient, exchanging information about patient transition to different care settings, reporting errors and resolving them, and helping the patient with appointments and transportation. The second category involves monitoring, sometimes combined with communication, with flow or shared resources interdependencies or both. This category includes reviewing medications and services and detecting errors, reviewing patient symptoms and following up if needed, and scheduling follow-up to review patient status. The last category involves communication with simultaneity interdependency. This category involves talking in the same location and developing a plan of care, people exchanging information at the same time, and scheduling delivery of medications/services to correspond with patient arrival home. Finally, we identified characteristics of health information technology that can support these various care coordination activities.
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Hoonakker PLT, Carayon P, Salwei ME, Hundt AS, Wiegmann D, Kleinschmidt P, Pulia MS, Wang Y, Novak C, Patterson BW. The Design of PE Dx, a CDS to Support Pulmonary Embolism Diagnosis in the ED. Stud Health Technol Inform 2019; 265:134-140. [PMID: 31431589 DOI: 10.3233/shti190152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Designing and implementing clinical decision support (CDS) in health care has been challenging. Attempts have been made to design and implement CDS to support clinical procedures, but many of these CDSs have met user resistance. One possible explanation for the lack of acceptability can be the poor design of the CDS. In this study, we describe the design of PE Dx, a CDS built to support the diagnosis of pulmonary embolism (PE) in the emergency department (ED) using human factors methods.
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Affiliation(s)
| | | | | | - Ann S Hundt
- University of Wisconsin-Madison, Madison WI, 53726, USA
| | | | - Peter Kleinschmidt
- University of Wisconsin-Madison, Madison WI, 53726, USA.,UW Health, Madison WI, 53726, USA
| | - Michael S Pulia
- University of Wisconsin-Madison, Madison WI, 53726, USA.,UW Health, Madison WI, 53726, USA
| | - Yudi Wang
- University of Wisconsin-Madison, Madison WI, 53726, USA
| | | | - Brian W Patterson
- University of Wisconsin-Madison, Madison WI, 53726, USA.,UW Health, Madison WI, 53726, USA
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Abstract
Developing structures and processes for continuous sociotechnical system design is key to sustaining human factors (HF) knowledge in the context of rapid health care changes and technological innovations. Two research studies illustrate how to embed HF in organizational learning processes and structures. We need to develop innovative HF methods for continuous sociotechnical system design.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial & Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Wooldridge A, Carayon P, Hoonakker P, Hose BZ, Ross J, Kohler JE, Brazelton T, Eithun B, Kelly MM, Dean SM, Rusy D, Durojaiye A, Gurses AP. Complexity of the pediatric trauma care process: Implications for multi-level awareness. Cogn Technol Work 2019; 21:397-416. [PMID: 31485191 PMCID: PMC6724740 DOI: 10.1007/s10111-018-0520-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/23/2018] [Indexed: 06/02/2023]
Abstract
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e. safety in complex systems. We discuss three levels of awareness (individual, team and organizational) and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration and decision making. A challenge to team awareness is inadequate "non-technical" skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, by using process modeling or simulation.
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Affiliation(s)
- Abigail Wooldridge
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC 9123, Madison WI 53705, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Department of Surgery Administration MC: 7375, Madison WI 53792, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison WI 53792, USA
| | - Michelle M Kelly
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ashimiyu Durojaiye
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
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Hoonakker PLT, Wooldridge AR, Hose BZ, Carayon P, Eithun B, Brazelton TB, Kohler JE, Ross JC, Rusy DA, Dean SM, Kelly MM, Gurses AP. Information flow during pediatric trauma care transitions: things falling through the cracks. Intern Emerg Med 2019; 14:797-805. [PMID: 31140061 PMCID: PMC6692560 DOI: 10.1007/s11739-019-02110-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Every year, nearly 10 million children are evaluated in emergency departments (EDs) for traumatic injuries, resulting in 250,000 hospital admissions and 10,000 deaths. Pediatric trauma care in hospitals is distributed across time and space, and particularly complex with involvement of large and fluid care teams. Several clinical teams (including emergency medicine, surgery, anesthesiology, and pediatric critical care) converge to help support trauma care in the ED; this co-location in the ED can help to support communication, coordination and cooperation of team members. The most severe trauma cases often need surgery in the operating room (OR) and are admitted to the pediatric intensive care unit (PICU). These care transitions in pediatric trauma can result in loss of information or transfer of incorrect information, which can negatively affect the care a child will receive. In this study, we interviewed 18 clinicians about communication and coordination during pediatric trauma care transitions between the ED, OR and PICU. After the interview was completed, we surveyed them about patient safety during these transitions. Results of our study show that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To safely manage the transition of this fragile and complex population, we need to find ways to better manage the information flow during these transitions by, for instance, providing technological support to ensure shared mental models.
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Affiliation(s)
- Peter Leonard Titus Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3124 Engineering Centers Building, 1550 Engineering Drive, Madison, WI, 53706, USA.
| | - Abigail Rayburn Wooldridge
- Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, 209A Transportation Building, 104 South Mathews Avenue, Urbana, IL, 61801, USA
| | - Bat-Zion Hose
- Center for Quality and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3139 Engineering Centers Building, 1550 Engineering Drive, Madison, WI, 53706, USA
| | - Pascale Carayon
- Center for Quality and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3139 Engineering Centers Building, 1550 Engineering Drive, Madison, WI, 53706, USA
| | - Ben Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison, WI, 53792, USA
| | - Thomas Berry Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Jonathan Emerson Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Joshua Chud Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Deborah Ann Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Shannon Mason Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michelle Merwood Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Ayse Pinar Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15th Floor, Baltimore, MD, 21202, USA
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Abstract
OBJECTIVES Despite national mandates, incentives, and other programs, the design of health information technology (IT) remains problematic and usability problems continue to be reported. This paper reviews recent literature on human factors and usability of health IT, with a specific focus on research aimed at applying human factors methods and principles to improve the actual design of health IT, its use, and associated patient and clinician outcomes. METHODS We reviewed recent literature on human factors and usability problems of health IT and research on human-centered design of health IT for clinicians and patients. RESULTS Studies continue to show usability problems of health IT experienced by multiple groups of health care professionals (e.g., physicians and nurses) as well as patients. Recent research shows that usability is influenced by both designers (e.g., IT vendors) and implementers in health care organizations, and that the application of human-centered design practices needs to be further improved and extended. We welcome emerging research on the design of health IT for teams as team-based care is increasingly implemented throughout health care. CONCLUSIONS Progress in the application of human factors methods and principles to the design of health IT is occurring, with important information provided on their actual impact on care processes and patient outcomes. Future research should examine the work of health IT designers and implementers, which would help to develop strategies for further embedding human factors engineering in IT design processes.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, USA
| | - Peter Hoonakker
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, USA
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Carayon P, Hundt AS, Hoonakker P. Technology barriers and strategies in coordinating care for chronically ill patients. Appl Ergon 2019; 78:240-247. [PMID: 31046955 PMCID: PMC6529186 DOI: 10.1016/j.apergo.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 05/18/2023]
Abstract
Care managers who coordinate care for chronically ill patients in hospitals and outpatient settings use multiple health information technologies for accessing, processing, documenting, and communicating patient-related information. Using a combination of 41 interviews and observations of 15 care managers, we identified a range of technology-related barriers experienced by care managers (total of 163 occurrences). The barriers are related to (lack of) access to information, inadequate information, limited usefulness and usability of the technologies, challenges associated with using multiple health IT, and technical problems. In 43% of the occurrences, care managers describe strategies to deal with the technology barriers; these fit in three categories: nothing/delay (9 occurrences), work-arounds (32 occurrences), and direct action at the individual, team, and organization levels (29 occurrences). Our data show the adaptive capacity of care managers who develop various strategies to deal with technology barriers and are, therefore, able to care for chronically ill patients. This information can be used as input to work system redesigns.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA; Center for Quality and Productivity Improvement, University of Wisconsin-Madison, USA.
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, USA
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, USA
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Salwei ME, Carayon P, Hundt AS, Hoonakker P, Agrawal V, Kleinschmidt P, Stamm J, Wiegmann D, Patterson BW. Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis. Ergonomics 2019; 62:864-879. [PMID: 30943873 PMCID: PMC7243844 DOI: 10.1080/00140139.2019.1603402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 06/04/2023]
Abstract
Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient's hospitalisation, presenting five stages with different levels of complexity: admission, interruption, re-initiation, initiation, and transfer. The objective of our study is to understand how the VTE prophylaxis team adapts as the complexity in the process changes; we do this by using social network analysis (SNA) measures. We interviewed 45 clinicians representing 9 different cases, creating 43 role networks. The role networks were analysed using SNA measures to understand team changes between low and high complexity stages. When comparing low and high complexity stages, we found two team adaptation mechanisms: (1) relative increase in the number of people, team activities, and interactions within the team, or (2) relative increase in discussion among the team, reflected by an increase in reciprocity. Practitioner Summary: The reason for this study was to quantify team adaptation to complexity in a process using social network analysis (SNA). The VTE prophylaxis team adapted to complexity by two different mechanisms, by increasing the roles, activities, and interactions among the team or by increasing the two-way communication and discussion throughout the team. We demonstrated the ability for SNA to identify adaptation within a team.
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Affiliation(s)
- Megan E. Salwei
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, USA, 53706
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, USA, 53706
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Vaibhav Agrawal
- Geisinger Health System, 100 North Academy Avenue, Danville, USA, 17822
| | - Peter Kleinschmidt
- School of Medicine and Public Health, University of Wisconsin-Madison, 750 Highland Avenue, Madison, USA, 53726
| | - Jason Stamm
- Geisinger Health System, 100 North Academy Avenue, Danville, USA, 17822
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, USA, 53706
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Brian W. Patterson
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
- School of Medicine and Public Health, University of Wisconsin-Madison, 750 Highland Avenue, Madison, USA, 53726
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Hose BZ, Hoonakker PLT, Wooldridge AR, Brazelton III TB, Dean SM, Eithun B, Fackler JC, Gurses AP, Kelly MM, Kohler JE, McGeorge NM, Ross JC, Rusy DA, Carayon P. Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care. Appl Clin Inform 2019; 10:113-122. [PMID: 30759492 PMCID: PMC6374147 DOI: 10.1055/s-0039-1677737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. METHODS We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline. RESULTS We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. CONCLUSION Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.
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Affiliation(s)
- Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Peter L. T. Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Abigail R. Wooldridge
- Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
| | - Thomas B. Brazelton III
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Shannon M. Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Ben Eithun
- American Family Children’s Hospital, University of Wisconsin School of medicine and Public Health, Madison, Wisconsin, United States
| | - James C. Fackler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Department of Anesthesiology and Critical Care Medicine, School of Medicine; Department of Health Sciences Informatics, School of Medicine; Department of Health Policy and Management, Bloomberg School of Public Health; Carey Business School; Malone Center for Engineering in Healthcare, Whiting School of Engineering; Johns Hopkins University, Baltimore, Maryland, United States
| | - Michelle M. Kelly
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Jonathan E. Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Nicolette M. McGeorge
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Joshua C. Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Deborah A. Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
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