The Standardization of the Emergency Department Response to Chemical, Biological, Radiological, and Nuclear (CBRN) Events: Human Factors/Ergonomics Approach.

OBJECTIVE: To provide standardized recommendations for the emergency department (ED) response to chemical, biological, radiological, and nuclear (CBRN) events by combining the human factors/ergonomics method of hierarchical task analysis with the theoretical framework for Work as Imagined versus Work as Done. METHODS: Document analyses were used to represent CBRN response operational procedures. Semi-structured interviews using scenario cards were carried out with 57 first receivers (ED staff) to represent CBRN practice at 2 acute hospitals in England. RESULTS: Variability existed in general organizational responsibilities associated with the CBRN response. Variability was further evident in top level CBRN tasks and CBRN phases at both EDs. Operational procedures focused on tasks such as documentation, checking, and timing. CBRN practice focused on patient needs through assessment, treatment, and diagnosis. CONCLUSION: The findings provide top-down and bottom-up insights to enhance the ED CBRN response through standardization. The standardized CBRN action card template embeds the choice approach to standardization. The standardized CBRN framework implements the streamlined categorization of CBRN phases. Work as Imagined versus Work as Done is a useful theoretical framework to unpack a complex sociotechnical system, and hierarchical task analysis is an effective system mapping tool in health care.

The contribution of human factors and ergonomics to the design and delivery of safe future healthcare.

Human factors and ergonomics (HF/E) is concerned with the design of work and work systems. There is an increasing appreciation of the value that HF/E can bring to enhancing the quality and safety of care, but the professionalisation of HF/E in healthcare is still in its infancy. In this paper, we set out a vision for HF/E in healthcare based on the work of the Chartered Institute of Ergonomics and Human Factors (CIEHF), which is the professional body for HF/E in the UK. We consider the contribution of HF/E in design, in digital transformation, in organisational learning and during COVID-19.

DEEP SCOPE: A Framework for Safe Healthcare Design.

Thinking in patient safety has evolved over time from more simplistic accident causation models to more robust frameworks of work system design. Throughout this evolution, less consideration has been given to the role of the built environment in supporting safety. The aim of this paper is to theoretically explore how we think about harm as a systems problem by mitigating the risk of adverse events through proactive healthcare facility design. We review the evolution of thinking in safety as a safety science. Using falls as a case study topic, we use a previously published model (SCOPE: Safety as Complexity of the Organization, People, and Environment) to develop an expanded framework. The resulting theoretical model and matrix, DEEP SCOPE (DEsigning with Ergonomic Principles), provide a way to synthesize design interventions into a systems-based model for healthcare facility design using human factors/ergonomics (HF/E) design principles. The DEEP SCOPE matrix is proposed to highlight the design of safe healthcare facilities as an ergonomic problem of design that fits the environment to the user by understanding built environments that support the "human" factor.

Integration of human factors/ergonomics in healthcare systems: A giant leap in safety as a key strategy during Covid-19.

In this article, we present a model for integrating Human Factors/Ergonomics (HFE) into healthcare systems to make them more robust and resilient. We believe that to increase the impact of HFE during and after the Covid-19 pandemic this integration should be carried out simultaneously at all levels (micro, meso, and macro) of the healthcare system. This new model recognizes the interrelationship between HFE and other system characteristics such as capacity, coverage, robustness, integrity, and resilience. We hope that the model will serve as a reference for a giant leap to design and improve the safety and effectiveness of healthcare services from a holistic (systems) perspective.

Medical stretching devices are effective in the treatment of knee arthrofibrosis: A systematic review.

AIMS: This systematic review examines the available evidence on the use of medical stretching devices to treat knee arthrofibrosis, it suggests a focus for future studies addressing limitations in current research and identifies gaps in the published literature to facilitate future works. MATERIALS AND METHODS: Articles were identified using the Cochrane Library, MEDLINE, PubMed and SCOPUS databases. Articles from peer reviewed journals investigating the effectiveness of medical stretching devices to increase range of movement when treating arthrofibrosis of the knee were included. RESULTS: A total of 13 studies (558 participants) met the inclusion criteria with the devices falling into the following categories; CPM, load control or displacement control stretching devices. A statistically significant increase in range of movement was demonstrated in CPM, load-control and displacement-control studies (p â€‹< â€‹0.001). The results show that the stretch doses applied using the CPM, load-control devices were performed over a considerably longer treatment time and involved significantly more additional physiotherapy compared to the displacement-control and patient actuated serial stretching devices. CONCLUSION: The systematic review indicates that load-control and displacement-control devices are effective in increasing range of movement in the treatment of knee arthrofibrosis. Displacement-control devices involving patient actuated serial stretching techniques, may be more effective in increasing knee flexion than those utilising static progressive stretch.The paucity of research in this field indicates that more randomised controlled trials are required to investigate the superiority of the different types of displacement-control stretching devices and which of these would be most effective for use in clinical practice and to compare these with standard physiotherapy treatment.

Frontiers in human factors: integrating human factors and ergonomics to improve safety and quality in Latin American healthcare systems.

BACKGROUND: The importance of human factors/ergonomics (HFE) is well established in all high-reliability systems but only applied in the healthcare sector relatively recently. Across many sectors, low-/middle-income countries (LMICs) lag behind more economically developed countries in their application of this safety science, due to resource and, in some cases, awareness and expertise. Most previous applications of HFE related to occupational ergonomics rather than healthcare safety. METHODS: The paper details how the reputation of HFE is being developed within healthcare communities of Latin America (LatAm), through increasing awareness and understanding of its role as safety science in the healthcare sector. It starts by articulating the need for HFE and then provides examples from Mexico, Colombia and Peru. RESULTS: The practical examples for research and education illustrate a developing awareness of the relevance of HFE to the healthcare sectors in LatAm and an appreciation of its worth to improve health service quality and patient safety through healthcare community engagement. A new LatAm Network of HFE in Healthcare Systems (RELAESA) was formed in 2019, which has provided a platform for HFE advice during the COVID-19 pandemic. CONCLUSION: There is a real opportunity in LatAm and other LMIC health services to make more rapid and sustainable progress in healthcare-embedded HFE than has been experienced within healthcare services of more developed nations.

Human factors/ergonomics to support the design and testing of rapidly manufactured ventilators in the UK during the COVID-19 pandemic.

BACKGROUND: This paper describes a rapid response project from the Chartered Institute of Ergonomics & Human Factors (CIEHF) to support the design, development, usability testing and operation of new ventilators as part of the UK response during the COVID-19 pandemic. METHOD: A five-step approach was taken to (1) assess the COVID-19 situation and decide to formulate a response; (2) mobilise and coordinate Human Factors/Ergonomics (HFE) specialists; (3) ideate, with HFE specialists collaborating to identify, analyse the issues and opportunities, and develop strategies, plans and processes; (4) generate outputs and solutions; and (5) respond to the COVID-19 situation via targeted support and guidance. RESULTS: The response for the rapidly manufactured ventilator systems (RMVS) has been used to influence both strategy and practice to address concerns about changing safety standards and the detailed design procedure with RMVS manufacturers. CONCLUSION: The documents are part of a wider collection of HFE advice which is available on the CIEHF COVID-19 website (https://covid19.ergonomics.org.uk/).

Chris and Sally's House: Adapting a home for people living with dementia (innovative practice).

How can domestic housing be adapted to support people living with dementia staying in their own homes for as long as they choose? This paper describes the innovative practice of using evidence-based design personas in a building refurbishment project (Chris and Sally's House) with a multidisciplinary team of architects, ergonomists, psychologists and experts. A 100 sqm Victorian two bedroom house was adapted to help educate house builders, carers and relatives on how to better support those living with dementia to live in their own home for longer. The design principles include clear sight lines, mobility support and provision for overnight carers.

Frontiers in human factors: embedding specialists in multi-disciplinary efforts to improve healthcare.

Despite the application of a huge range of human factors (HF) principles in a growing range of care contexts, there is much more that could be done to realize this expertise for patient benefit, staff well-being and organizational performance. Healthcare has struggled to embrace system safety approaches, misapplied or misinterpreted others, and has stuck to a range of outdated and potentially counter-productive myths even has safety science has developed. One consequence of these persistent misunderstandings is that few opportunities exist in clinical settings for qualified HF professionals. Instead, HF has been applied by clinicians and others, to highly variable degrees-sometimes great success, but frequently in limited and sometimes counter-productive ways. Meanwhile, HF professionals have struggled to make a meaningful impact on frontline care and have had little career structure or support. However, in the last few years, embedded clinical HF practitioners have begun to have considerable success that are now being supported and amplified by professional networks. The recent coronavirus disease of 2019 (COVID-19) experiences confirm this. Closer collaboration between healthcare and HF professionals will result in significant and ultimately beneficial changes to both professions and clinical care.

Midwives' thoughts about musculoskeletal disorders with an evaluation of working tasks.

The prevalence of musculoskeletal disorders is very high amongmidwives resulting in sickness absenteeism, functional limitation and staff shortages. There are several contributory risk factors having impact on the development of MSDs. This study aimed to (1) explore midwives' experiences and views about work-related MSDs and contributing risk factors, and (2) analyse working postures for musculoskeletal injury risks. A mixed method approach was used with interviews/focus group (n = 15/7) and observations (n = 22) of specific tasks (during birth and after birth) using the posture analysis observational method (Rapid Entire Body Assessment, REBA). The participants were midwives who had an active role in the United Kingdom (UK) National Health Services (NHS). It was found that MSDs were often attributed to the physical (working in awkward positions), organisational (longer shift hours, fewer staff, increased work load), psychosocial (defensive practice, higher demand) challenges of midwifery. All postures had very high to medium REBA risk levels with action categories indicating that action or further assessment is definitely necessary to reduce MSDs. This research provides a holistic approach by analysing risk factors and interactions in the work context to inform the development of risk management strategies. Midwifery working conditions have a big impact on developing musculoskeletal symptoms. Management of such symptoms will improve staff wellbeing, mother and baby safety, individuals' life trajectories and staff shortages.

The STAK tool: evaluation of a new device to treat arthrofibrosis and poor range of movement following total knee arthroplasty and major knee surgery.

AIMS: This study aims to evaluate a new home medical stretching device called the Self Treatment Assisted Knee (STAK) tool to treat knee arthrofibrosis. METHODS: 35 patients post-major knee surgery with arthrofibrosis and mean range of movement (ROM) of 68° were recruited. Both the STAK intervention and control group received standard physiotherapy for eight weeks, with the intervention group additionally using the STAK at home. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Scores (OKS) were collected at all timepoints. An acceptability and home exercise questionnaire capturing adherence was recorded after each of the interventions. RESULTS: Compared to the control group, the STAK intervention group made significant gains in mean ROM (30° versus 8°, p < 0.0005), WOMAC (19 points versus 3, p < 0.0005), and OKS (8 points versus 3, p < 0.0005). The improvements in the STAK group were maintained at long-term follow-up. No patients suffered any complications relating to the STAK, and 96% of patients found the STAK tool 'perfectly acceptable'. CONCLUSION: The STAK tool is effective in increasing ROM and reducing pain and stiffness. Patients find it acceptable and adherence to treatment was high. This study indicates that the STAK tool would be of benefit in clinical practice and may offer a new, cost-effective treatment for arthrofibrosis.Cite this article: Bone Joint Open 2020;1-8:465-473.

Tertiary education in ergonomics and human factors: quo vadis?

In 2019, the Human Factors and Ergonomics (HFE) discipline turned 70; to celebrate, an international group of academics and educators have reflected on the status of HFE tertiary education across the globe. This paper draws on presentations and discussions from the 20th Triennial International Ergonomics Association (IEA) conference and considers the implications for HFE education programmes. Past, current, and future challenges are outlined and discussed with examples from different countries and programmes. This paper builds on 2012 strategy proposed by Dul and colleagues, to strengthen the demand, and application, of the HFE discipline and profession. It provides a considered set of reflections, noting the range of structural issues and financial pressures within the tertiary education system that create challenges for the viability of specialist programmes such as HFE. A need exists for the broader profession to collaborate and share innovations in HFE programme development, to ensure sustainable HFE education programmes. Practitioner summary: A range of structural issues and financial pressures exist within the tertiary education system that creates challenges for the viability of specialist programmes such as HFE. A need exists for the broader profession to collaborate and share innovations in HFE programme development, to ensure sustainable HFE education programmes. Abbreviation: HFE: Human Factors and Ergonomics; IEA: International Ergonomics Association; CIEHF: Chartered Institute of Ergonomics & Human Factors; UX: User Experience; CREE: Centre for Registration of European Ergonomist; BRICSplus: Brazil, Russia, India, China and South Africa; MOOCS: Massive Open Online Courses; STST: socio technical systems theory; LMIC: low and middle-income countries.

Midwives are getting hurt: UK survey of the prevalence and risk factors for developing musculoskeletal symptoms.

OBJECTIVE: To investigate the prevalence, severity and impact of musculoskeletal disorders (MSDs) and to explore individual, work-related and psychosocial risk factors DESIGN: A cross sectional survey SETTING: A self-reported online questionnaire was used to collect data over seven months (May-December 2016). PARTICIPANTS: The survey was distributed to midwives across the United Kingdom through the Consultant Midwives Network and the Royal College of Midwives. MEASUREMENTS AND FINDINGS: Prevalence, severity and impact (12-month) of MSDs for nine body parts are presented. The associations between individual, occupational and psychosocial factors and symptoms are examined using Independent samples t-test or Chi-square statistical analyses, with Logistic regression analysis to understand the relative importance of variables. It was found that 92% of the participants reported MSDs, most commonly in the low back (71%), neck (45%) and shoulders (45%). Symptoms impacted on normal activities at work and/or leisure (50%), sick leave (30%) and jobs/duties (45%). Age and time practicing in midwifery were inversely associated with low back symptoms; reported less frequently with increasing age and experience. Longer working hours was a predictor for shoulder symptoms. Over commitment (intrinsic job stress) was associated with neck and more strongly with shoulder symptoms. Those caring for a dependent adult for more than 50 h a week were 4.54 times more likely to have neck discomfort. KEY CONCLUSIONS: This first survey of UK Midwives reveals a very high prevalence of low back, neck and shoulder symptoms, resulting in sickness absenteeism, reduction in normal activities and changing roles. Age, years in practice, body mass index, working hours, job satisfaction and job stress are contributory factors. IMPLICATIONS FOR PRACTICE: This study highlights the prevalence and impact of musculoskeletal symptoms and the potential harmful impacts on their working life and patient care. The findings will promote risk-awareness and national actions for risk management.

Plus size and obese workers: anthropometry estimates to promote inclusive design.

A significant proportion of the adult population globally is overweight, obese or classed as 'plus size'. This has led to variability in size and shape across the working population and exclusion in the workplace. A new dataset of the anthropometry of plus size people has been created. Length dimensions were similar to other data, but breadth, circumference, and depth measurements were substantially larger. The hip breadth and abdominal depth were important for predicting largeness in this population. These data help explain the high exclusion rates from design and the number of fit, reach, posture and clearance issues reported by participants with a high BMI: generally, the higher the BMI the greater prevalence of problems. It is hoped that a better understanding of the anthropometric characteristics of the plus size worker will inform the design of safe, productive work environments to promote inclusion for a wider range of people. Practitioner Summary: A new anthropometry dataset of plus size people has been created. The higher the BMI the greater the problems with design in the workplace for fit, reach, posture and clearance. To ensure inclusion and reduce stigma it is important to understand more about the size and shape of this population.

Existing Science on Human Factors and Ergonomics in the Design of Ambulances and EMS Equipment.

Background: Emergency medical services (EMS) personnel face a disproportionally high risk for fatality and injury due to the nature of their work; and current ambulance and EMS equipment design standards do not adequately safeguard EMS personnel from sacrificing personal safety for patient care, a known human factors and ergonomic (HFE) design challenge. Despite the desire to include HFE interventions or considerations into a standard, the effectiveness of existing HFE interventions for EMS is unclear. Objective: Therefore, this study aimed to synthesize the peer-reviewed literature on the design features of patient compartments and EMS equipment that affect EMS personnel's performance or well-being. Methods: A scoping review methodology was applied to systematically search and screen for relevant articles, and extract data. Three databases (EmBase, Scopus, and PubMed) were searched, and search results were screened for articles that pertained to the performance or well-being of EMS personnel when interacting with the patient compartment or its associated equipment. Results and Discussion: Of the 4,125 search results, 48 relevant articles were retained, and then sorted into one of 3 categories: general design, patient handling, and patient transport. It was concluded that, although research has progressed over the past 15 years, more research, development, and resources are needed. Newer generations of ambulances have not been shown to be safer during collisions and there is a knowledge gap in how occupants and contents of a patient compartment behave during a collision. Crash-tests have been performed with restrained occupants and supplies; however, that scenario is unrealistic in the field. While the existing literature provided initial ideas and innovations for improving the HFE of patient handling and patient transport, it is important for future research to convey findings in a manner that can be used to inform design standards.

Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review.

IntroductionA Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) event is an emergency which can result in injury, illness, or loss of life. The emergency department (ED) as a health system is at the forefront of the CBRNe response with staff acting as first receivers. Emergency departments are under-prepared to respond to CBRNe events - recognizing key factors which underlie the ED CBRNe response is crucial to provide evidence-based knowledge to inform policies and, most importantly, clinical practice.ProblemChallenges in detection, decontamination, and diagnosis are associated with the ED CBRNe response when faced with self-presenting patients. METHODS: A systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia). RESULTS: Sixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.DiscussionThis study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED. CONCLUSION: The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures. RazakS, HignettS, BarnesJ. Emergency department response to chemical, biological, radiological, nuclear, and explosive events: a systematic review. Prehosp Disaster Med. 2018;33(5):543-549.

A UK Perspective on Human Factors and Patient Safety Education in Pharmacy Curricula.

Objective. To take a systematic approach to exploring patient safety teaching in health care curricula, particularly in relation to how educators ensure students achieve patient safety competencies. Findings. There is a lack of formally articulated patient safety curricula, which means that student learning about safety is largely informal and influenced by the quality and culture of the practice environment. Human Factors and Ergonomics appeared largely absent from curricula. Summary. Despite its absence from health care curricula, Human Factors and Ergonomics approaches offer a vehicle for embedding patient safety teaching. The authors suggest a possible model, with Human Factors and Ergonomics forming the central structure around which the curriculum can be built.

More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England?

What prevents the delivery of effective, high quality and safe health care in the National Health Service (NHS) in England? This paper presents 760 challenges which 330 NHS staff reported as preventing the delivery of effective, high quality and safe care. Some problems have been known for over 25 years (staff shortages, finance and patient complexity) but other challenges raise questions about the commitment of the NHS to patient and staff safety. For example, Organisational Culture leading to 'stifling bureaucracy', 'odds stacked against smooth […] working' and Workload resulting in 'firefighting daily' and 'perpetual crisis mode'. The role of Human Factors/Ergonomics professional input (engagement with safety scientists) is discussed in the context of success stories and examples of Human Factors Integration from other safety critical industries (Defence, Nuclear and Rail). Practitioner Summary: 760 challenges to the quality, effectiveness and safety of health care were identified at Human Factors/Ergonomics taster workshops in England. These are used to challenge health care providers to think about a Human Factors Integration (HFI systems) approach for safety, well-being and performance for all people involved in providing and receiving health care.

Twelve tips for embedding human factors and ergonomics principles in healthcare education.

Safety and improvement efforts in healthcare education and practice are often limited by inadequate attention to human factors/ergonomics (HFE) principles and methods. Integration of HFE theory and approaches within undergraduate curricula, postgraduate training and healthcare improvement programs will enhance both the performance of care systems (productivity, safety, efficiency, quality) and the well-being (experiences, joy, satisfaction, health and safety) of all the people (patients, staff, visitors) interacting with these systems. Patient safety and quality improvement education/training are embedded to some extent in most curricula, providing a potential conduit to integrate HFE concepts. To support evolving curricula and professional development at all levels - and also challenge prevailing "human factors myths and misunderstandings" - we offer professional guidance as "tips" for educators on fundamental HFE systems and design approaches. The goal is to further enhance the effectiveness of safety and improvement work in frontline healthcare practice.