Human factors in healthcare最新文献

{"title":"A scoping review of work system elements that influence emergency department disposition decision-making","authors":"Rachel A. Rutkowski ,&nbsp;Eleanore Scheer ,&nbsp;Claire Carlson ,&nbsp;Reid Parks ,&nbsp;Michael S. Pulia ,&nbsp;Brian W. Patterson ,&nbsp;Manish N. Shah ,&nbsp;Peter L.T. Hoonakker ,&nbsp;Pascale Carayon ,&nbsp;Maureen Smith ,&nbsp;Leslie A. Christensen ,&nbsp;Nicole E. Werner","doi":"10.1016/j.hfh.2023.100059","DOIUrl":"https://doi.org/10.1016/j.hfh.2023.100059","url":null,"abstract":"<div><p>Emergency department (ED) disposition decision-making represents a critical juncture in patients’ care journeys, as it shapes the type of care patients access following an ED visit. However, there is a dearth of information related to how and in what context the disposition decision-making occurs. We conducted a scoping review to synthesize what previous studies reveal about the ED work system elements that influence disposition decision-making. A dual-coding screening process identified 27 articles from database searches. Articles were extracted and analyzed using the Systems Engineering Initiative for Patient Safety model. Most articles included at least two work system components. Our results suggest that the literature captures only some of the complexity of disposition decision-making, leaving certain elements underexplored or limited in scope. This review identifies informational gaps that, if addressed by future research, will support ED system redesigns that optimize patient, clinician, and organizational outcomes.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277250142300026X/pdfft?md5=69600b0b89898175bf089f8bf078c5bb&pid=1-s2.0-S277250142300026X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of memory for and affective response to health messages on self-care behavioral intentions","authors":"Renato Ferreira Leitão Azevedo ,&nbsp;Rocio Garcia-Retamero ,&nbsp;Daniel G. Morrow ,&nbsp;Mark Hasegawa-Johnson ,&nbsp;Kuangxiao Gu","doi":"10.1016/j.hfh.2023.100058","DOIUrl":"10.1016/j.hfh.2023.100058","url":null,"abstract":"<div><p>Clinical test results are often presented in digital health solutions (e.g., patient portals, mobile phone apps) with limited context to help patients understand implications of this numeric information. Guided by a framework that integrates cognitive and health behavior theories, we identified processes involved in understanding and responding to health messages as a basis for designing more effective digital health solutions that include clinical test results. This framework emphasizes the importance of presenting numeric information in ways that support memory, decision making, and action. In previous studies we measured memory for and affective response to messages about cholesterol and diabetes screening test results, perceived risk associated with these test results, as well as attitudes toward and intention to perform behaviors that address these risks (e.g., adherence to exercise recommendations). The focus of the present paper is to analyze direct and indirect relationships among these health decision making and behavioral variables through multivariate path analyses. Consistent with previous findings, we found that memory for messages was only indirectly related to behavioral attitudes and intentions. Affective responses to risk-related information, on the other hand, directly related to these variables, perhaps because behavioral attitudes and intentions are often based on information organized around affective/evaluative dimensions. These results suggest appropriate affective response may not only directly support risk perception, but attitudes toward behavior addressing this risk. We discuss implications for human factors and ergonomics researchers and practitioners to the design, implementation and evaluation of digital health solutions.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772501423000258/pdfft?md5=713ca1dfe0636bda0b1e26d025bf79ab&pid=1-s2.0-S2772501423000258-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding how infection prevention influences nurses' task sequencing using a mixed-methods, simulation-based approach","authors":"Bradley W. Weaver ,&nbsp;Joel M. Mumma ,&nbsp;Sweta Parmar ,&nbsp;Rebecca E. MacKay ,&nbsp;Jill S. Morgan ,&nbsp;Golpar Ghassemian ,&nbsp;Paige R. Gannon ,&nbsp;Lindsay Lee","doi":"10.1016/j.hfh.2023.100046","DOIUrl":"10.1016/j.hfh.2023.100046","url":null,"abstract":"<div><h3>Objective</h3><p>Better understand how and why nurses sequence their patient care tasks.</p></div><div><h3>Background</h3><p>Workflow mitigation strategies, such as working clean to dirty, could help reduce cross-contamination. However, the extent to which priorities, other than infection prevention concerns, influence the sequence of patient care tasks is poorly understood.</p></div><div><h3>Methods</h3><p>We had nurses perform high fidelity simulations of patient care tasks that incorporated common barriers to practicing infection prevention, such as time pressure, high workload, and interruptions. We assigned nurses patient care tasks that were either high or low in patient-infection risk and either high or low in dirtiness; a two-way repeated measures ANOVA was used to analyze the effect of these two factors on the order in which nurses completed the tasks. We used a cued-retrospective think-aloud to elicit why participants sequenced the tasks the way they did; open and closed card sorts were used to analyze this data.</p></div><div><h3>Results</h3><p>On average, participants completed low patient-infection risk, high dirtiness tasks first followed by low dirtiness tasks (regardless of patient-infection risk) and then finally high patient-infection risk, high dirtiness tasks. Analysis of the think-alouds suggest patient stability and patient comfort were, on average, higher priorities for task sequencing than infection prevention.</p></div><div><h3>Conclusion</h3><p>Healthcare workers have to balance competing priorities such as patient stability, patient comfort, and infection prevention concerns with the limited resources (e.g., staff, supplies, time) available to them. Future research examining how different task sequence approaches might affect these priorities would help inform how healthcare workers could sequence their tasks.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100046"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46266223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The design and evaluation of a syringe hub for organizing syringes in anesthesia medication delivery","authors":"Harrison Sims ,&nbsp;Joshua Biro ,&nbsp;Connor Lusk ,&nbsp;David M. Neyens ,&nbsp;Ken Catchpole ,&nbsp;Abdus Sabour Shaik ,&nbsp;Stephanie Munie ,&nbsp;James H. Abernathy III","doi":"10.1016/j.hfh.2023.100049","DOIUrl":"10.1016/j.hfh.2023.100049","url":null,"abstract":"<div><p>One of the most common errors in intraoperative medication delivery is the result of “syringe swap,” when syringes that have been mixed up lead to the incorrect administration of a drug. An improvement of syringe organization could reduce medication administration errors. Recently, there have been many efforts to improve medication organization; however, these interventions struggle to achieve widespread use, even though they typically report substantial improvements in error rates and medication awareness in home institutions.</p><p>A syringe organization hub was developed based on observations, interviews, and past designs. In order to assess the perceived acceptance of the hub, we used the Technology Acceptance Model (TAM) to develop a survey that was distributed to anesthesia providers at two medical institutions in the United States: one in the Mid-Atlantic and one in the southeast.</p><p>The results of the four different linear regression models revealed that participants at the southeastern institution had significantly lower usefulness ratings (<em>p</em>&lt;0.001), attitude ratings (<em>p</em>&lt;0.001), and behavioral intent ratings (<em>p</em>&lt;0.05) than participants at the Mid-Atlantic institution. The participants at the southeastern institution also reported more concerns about the implementation of the device, specifically regarding workflow deviation and cleanliness.</p><p>The hub design was heavily influenced by the workflows and work practices of the Mid-Atlantic institution, and survey results found that this may have created barriers for acceptance at the southeastern institution. We found that, as barriers continue to go unaddressed at a given institution, even the simplest device can become disruptive to workflow, and there can be a struggle with integration. When interventions are developed, they are typically designed to address the barriers at the native institution. However, when seeking widespread adoption, small barriers to acceptance at non-native institutions can prevent adoption of interventions as they are not inherently factored into the design. Therefore, widespread adoption can only be accomplished by expanding the number of institutions in the design process, thereby accounting for the barriers to adoption and acceptance.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100049"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48654750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigative approaches: Lessons learned from the RaDonda Vaught case","authors":"Kimberly N. Williams ,&nbsp;Crystal M. Fausett ,&nbsp;Elizabeth H. Lazzara ,&nbsp;Yuval Bitan ,&nbsp;Anthony Andre ,&nbsp;Joseph R. Keebler","doi":"10.1016/j.hfh.2023.100054","DOIUrl":"10.1016/j.hfh.2023.100054","url":null,"abstract":"<div><p>Accidental patient harms occur frequently in healthcare, but their exact prevalence and interventions that will best prevent them are still poorly understood. In rare cases, healthcare providers who have contributed to accidental patient harm may be criminally prosecuted to obtain justice for the patient and family or to set an example, which theoretically prevents other providers from making similar mistakes due to fear of punishment. A recent case where this strategy was chosen is the <em>RaDonda</em> L. <em>Vaught</em> vs<em>. Tennessee</em> (2022) criminal case. The present article discusses this case and its ramifications, as well as provides concrete recommendations for actions that healthcare organizations should take to foster a safer and more resilient healthcare system. Recommendations include placing an emphasis on just culture; ensuring timely, systems-level investigations of all incidents; refining and bolstering participation in national reporting systems; incorporating Human Factors professionals at multiple levels of organizations; and establishing a national safety board for medicine.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100054"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48987571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse knowledge and confidence in the care of mechanically ventilated patients in the emergency department","authors":"Susan Sanders Hendrix,&nbsp;Haresh D. Rochani","doi":"10.1016/j.hfh.2023.100052","DOIUrl":"10.1016/j.hfh.2023.100052","url":null,"abstract":"<div><p>Emergency nurses are responsible for the care of mechanically ventilated patients. Evidence-based care to prevent ventilator-associated pneumonia (VAP) must be initiated in the Emergency Department (ED) instead of after arrival in the critical care areas of the hospital. Nurses were surveyed assessing VAP prevention measures education, knowledge, and confidence. Nurses reported seldom to never monitoring patient/ventilator interactions (44.6%) and troubleshooting alarms (seldom/never: 48.9%) with confidence levels minimal (29.1%), moderate (54.1%) and high (14.5%). Nurses are responsible for titrating sedation but report contacting a respiratory therapist (RT) for all other ventilator management. ED nurses may not have the same exposure to VAP prevention education as their counterparts in the critical care areas. Increasing ED nurse knowledge and confidence in VAP prevention is necessary as EDs increasingly care for mechanically ventilated patients.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44655883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving quality of care for patients receiving care through telehealth in the time of COVID-19 global pandemic and beyond: HCI-based leading indicators for virtual visits","authors":"Yalda Khashe ,&nbsp;Maryam Tabibzadeh ,&nbsp;Najmedin Meshkati","doi":"10.1016/j.hfh.2023.100050","DOIUrl":"10.1016/j.hfh.2023.100050","url":null,"abstract":"<div><p>The COVID-19 pandemic expedited the growing rate of reliance on telehealth, as it provided a safer option for patients to seek the care they need and avoid potential negative consequences of being exposed to the COVID-19 virus. The aim of this study is to develop a series of Human-Computer Interaction (HCI)-based leading indicators to proactively analyze and evaluate the user interface in telehealth and virtual visits. Building on Nielsen's usability heuristics and mapping them to the six aspects of quality of care introduced by the Institute of Medicine, we identified the design features that had the highest impact on the quality of care and developed a list of leading indicators for each feature. Further, we developed corresponding checklists for each leading indicator to evaluate the features of the user. Beyond the benefits of telehealth for both patients and healthcare providers during atypical circumstances, the changes prompted by the COVID-19 public health emergency have possibly altered the position of telehealth to the point that communicating through video and audio has become the new normal. Therefore, the importance of designing an interface to facilitate user interaction with the system and consequently with one another is of utmost importance.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100050"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48198329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical investigation of optimal bed height for egressing and ingressing hospital beds","authors":"Ahmad Raza Usmani ,&nbsp;Susan E. Kotowski ,&nbsp;Jay Kim ,&nbsp;Thomas R. Huston ,&nbsp;Kermit G. Davis","doi":"10.1016/j.hfh.2023.100053","DOIUrl":"10.1016/j.hfh.2023.100053","url":null,"abstract":"<div><h3>Aims and objectives</h3><p>To determine what bed heights are optimal for egress and ingress to the bed, based on quantitative measures and subjective perception.</p></div><div><h3>Background</h3><p>Many patient falls are related to the patient's interaction with the hospital bed. Beds with lower heights were introduced to reduce the impact of injury due to patient falls. However, low-height beds imposed different kinds of issues during ingress/egress without assistance, such as greater forces and increased inertia required to overcome the center of mass being below the knees.</p></div><div><h3>Design</h3><p>A cross-sectional controlled laboratory study with 24 healthy adults was conducted to assess the biomechanical parameters at different bed heights.</p></div><div><h3>Methodology</h3><p>The bed height ranged from 43 cm to 86 cm, in 2.54 cm increments (completed in random order). Two force plates measured ground reaction force and center of pressure. Perception of stability and difficulty were collected from the subject after each trial. Documentation of hand-support of subject was also recorded for each trial. A two-factor Analysis of Variance was conducted to determine the significance between ingress/egress and bed height with post hoc Tukey test to determine source for significance.</p></div><div><h3>Results</h3><p>Bed Height emerged as a significant factor in determining the ability to ingress/egress from a hospital bed. The results indicated that for medium bed heights (51–66 cm), ingress/egress were less difficult (1–2, on a scale of 10), more stable (approximately 9/10), and had less vertical ground reaction forces (&lt;1000 N).</p></div><div><h3>Conclusion</h3><p>The ingress/egress was found to be best executed at medium heights (51–66 cm) as participants performed better biomechanically and were more stable than lower or higher heights.</p></div><div><h3>Relevance to clinical practice</h3><p>The results conclude that hospitals should endorse policies to keep the bed heights between 51 and 66 cm for ingress and egress.</p></div><div><h3>Patient or public contribution</h3><p>No Patient or Public Contribution.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45999816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2","authors":"Megan E. Salwei ,&nbsp;Peter L.T. Hoonakker ,&nbsp;Michael Pulia ,&nbsp;Douglas Wiegmann ,&nbsp;Brian W. Patterson ,&nbsp;Pascale Carayon","doi":"10.1016/j.hfh.2023.100055","DOIUrl":"https://doi.org/10.1016/j.hfh.2023.100055","url":null,"abstract":"<div><p>With the growing implementation and use of health IT such as Clinical Decision Support (CDS), there is increasing attention on the potential negative impact of these technologies on patients (e.g., medication errors) and clinicians (e.g., increased workload, decreased job satisfaction, burnout). Human-Centered Design (HCD) and Human Factors (HF) principles are recommended to improve the usability of health IT and reduce its negative impact on patients and clinicians; however, challenges persist. The objective of this study is to understand how an HCD process influences the usability of health IT. We conducted a systematic retrospective analysis of the HCD process used in the design of a CDS for pulmonary embolism diagnosis in the emergency department (ED). Guided by the usability outcomes (e.g., barriers and facilitators) of the CDS use “in the wild” (see Part 1 of this research in the accompanying manuscript), we performed deductive content analysis of 17 documents (e.g., design session transcripts) produced during the HCD process. We describe if and how the design team considered the barriers and facilitators during the HCD process. We identified 7 design outcomes of the HCD process, for instance designing a workaround and making a design change to the CDS. We identify gaps in the current HCD process and demonstrate the need for a continuous health IT design process.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100055"},"PeriodicalIF":0.0,"publicationDate":"2023-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49764541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-implementation usability evaluation of a human factors-based clinical decision support for pulmonary embolism (PE) diagnosis (Dx): PE Dx Study Part 1","authors":"Megan E. Salwei ,&nbsp;Peter L.T. Hoonakker ,&nbsp;Michael Pulia ,&nbsp;Douglas Wiegmann ,&nbsp;Brian W. Patterson ,&nbsp;Pascale Carayon","doi":"10.1016/j.hfh.2023.100056","DOIUrl":"https://doi.org/10.1016/j.hfh.2023.100056","url":null,"abstract":"<div><p>While there is promise for health IT, such as Clinical Decision Support (CDS), to improve patient safety and clinician efficiency, poor usability has hindered widespread use of these tools. Human Factors (HF) principles and methods remain the gold standard for health IT design; however, there is limited information on how HF methods and principles influence CDS usability “in the wild”. In this study, we explore the usability of an HF-based CDS used in the clinical environment; the CDS was designed according to a human-centered design process, which is described in Carayon et al. (2020). In this study, we interviewed 12 emergency medicine physicians, identifying 294 excerpts of barriers and facilitators of the CDS. Sixty-eight percent of excerpts related to the HF principles applied in the human-centered design of the CDS. The remaining 32% of excerpts related to 18 inductively-created categories, which highlight gaps in the CDS design process. Several barriers were related to the physical environment and organization work system elements as well as physicians’ broader workflow in the emergency department (e.g., teamwork). This study expands our understanding of the usability outcomes of HF-based CDS “in the wild”. We demonstrate the value of HF principles in the usability of CDS and identify areas for improvement to future human-centered design of CDS. The relationship between these usability outcomes and the HCD process is explored in an accompanying Part 2 manuscript.</p></div>","PeriodicalId":93564,"journal":{"name":"Human factors in healthcare","volume":"4 ","pages":"Article 100056"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49746538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}