Measuring Potential Visual Exposure of Physicians During Shift-End Handoffs and Its Impact on Interruptions, Privacy, and Collaboration.

BACKGROUND: Frequent interruptions, inadequate privacy, and lack of collaboration are barriers to safe and efficient end-of-shift handoffs between emergency physicians. Varying levels of visibility to and from physicians can impact these outcomes. This study quantifies potential visual exposure of physicians in workstations with varying enclosure levels using isovist connectivity (IC) as a measure. Further, this study examines the association of IC with number of interruptions/hour, perceived collaboration, and privacy during handoffs. METHODS: In-person observations were conducted during 60 handoffs to capture interruptions. Surveys were administered to the incoming and outgoing physicians to garner their perceptions of the extent of interruptions, collaboration, and privacy. Spatial analysis was conducted using DepthmapX. RESULTS: Findings demonstrate significant differences in IC scores based on (a) physicians location within the workstation during; (b) handoff approach (individual or collaborative); (c) position during handoff (sitting or standing). Documented interruptions were highest in the high IC locations and lowest in the medium and low IC locations. Physicians in low IC locations perceived to have sufficient privacy to conduct handoffs. LIMITATIONS AND CONCLUSION: It should be noted that the three pods, each housing a physician workstation with different enclosure levels, varied in number of patient rooms, patient acuity, overall size, and the location of workstations. While contextual variables were considered to the extent possible, several other factors could have resulted in differences in number of interruptions and collaboration levels. This study provides design recommendations for handoff locations and a method to test emergency physician workstation designs prior to construction.

A mobile application-based home assessment tool for patients undergoing joint replacement surgery: A qualitative feasibility study.

BACKGROUND: Most adults prefer to age in place. However, the majority of homes are not designed to support resident needs, especially for adults undergoing joint replacement surgeries such as total knee arthroplasty (TKA) or total hip arthroplasty (THA). It is of paramount importance to proactively assess and modify the homes of adults undergoing TKA/THA such that they can safely transition home following surgery. Several tools utilize emerging technology like virtual reality, augmented reality, or teleconferencing to assess home environments. These are meant to be used by professionals like occupational therapists. However, the acceptance and uptake of simple technology like mobile applications for assessing homes proactively by residents has not been explored. OBJECTIVE: A qualitative exploratory study was conducted to evaluate the feasibility and potential acceptance of a mobile application for resident-initiated home assessment. METHODS: Semi-structured interviews were conducted with 22 patient-care partner dyads before and after THA/TKA to understand the perceived usefulness, likelihood of using a mobile application-based home assessment tool, and perceived barriers and facilitators of using the tool. RESULTS: About 68% of the patient-care partner dyads interviewed for this study perceived benefits of using a mobile application-based tool. All the participants who perceived the tool to be useful showed high likelihood of using it. A comparison of responses between pre-and post-surgery interviews revealed that around 50% of participants showed an increased intention of using an assessment tool after experiencing challenges in their homes post-surgery. Participants provided recommendations for key content, potential features to include in the assessment tool, and preferred formats (e.g., checklists, visuals, and videos). CONCLUSIONS: To increase acceptance of a mobile application-based home assessment tool, it is crucial that residents are made aware of the home environment challenges and the importance of an assessment tool to improve their safety and independence. The content, features, formats, and usability suggestions from the participants in this study provide a framework for health mobile application and interface developers to design a home assessment tool.

Pediatric Intensive Care Unit (PICU) Patient Room Design: Identifying Safety Risks in Mirrored Rooms Through a Graphical Systems Analysis.

OBJECTIVE: The objectives of this study are to graphically depict specific clinical challenges encountered in a mirrored pediatric intensive care unit patient room and to represent potential solutions to address these challenges using a systems approach. BACKGROUND: The intensive care unit (ICU) patient room is a highly complex patient care environment where the design of the room must support patient care delivery safely and efficiently. There is a lack of research examining how ICU design elements interact with other system components to impact patient care. METHODS: An observational case study method utilizing a systems approach was used to observe and graphically depict clinical challenges with mirrored room configurations and to identify potential solutions. Video recordings of the three clinical scenarios were analyzed in detail in conjunction with three rounds of interviews with a clinical expert. RESULTS: Equipment or task characteristics that require orienting to a specific side of a patient create challenges in a mirrored room. In order to deliver care safely and efficiently in the mirrored room, adaptations would be required including changing boom, equipment and team member locations, purchasing new equipment, staff training, and inventory management. Some procedures such as extracorporeal membrane oxygenation would be difficult to conduct safely in the mirrored room, even with significant adaptations. CONCLUSION: Solutions to the challenges presented in mirrored room configurations are multifaceted and require simultaneous and ongoing changes to multiple systems elements, while others can be addressed relatively easily, for example, purchasing new equipment.

Perceived Usability of Seating in an Outpatient Waiting Area: A Combined Approach Utilizing Virtual Reality and Actual Seating Prototypes.

OBJECTIVE: This study proposed a combined methodology to evaluate the perceived usability of healthcare seats that were first selected in a virtual waiting room which provided the context of use for the seats. BACKGROUND: There has been an increased interest in using virtual reality (VR) for evaluation of seating in interior environments. Although VR offers a less expensive approach compared to evaluating seats in situ, using VR has limitations as users cannot experience the actual seat prototypes. METHOD: Participants (N = 92) experienced a virtual waiting room with various seat groupings and were prompted with four task-based scenarios through which they selected a seat. After the VR phase, they experienced their selected seats in a lab and used an online questionnaire to evaluate the seating. Semi-structured interviews were conducted to garner similarities and differences in participants' experience of virtual and real seats. RESULTS: Three categories including comfort, support, and flexibility were extracted from the questionnaire. While support and comfort categories were highly ranked by participants, the category rankings varied depending on participants' age, gender, tasks, and seat types. Interviews revealed that there were differences in experience of the seating materials in VR versus reality, and therefore experiencing the real seats was useful in seating evaluation. CONCLUSIONS: The findings suggest that the combined methodology using VR and real seating in a lab is a reliable tool for designers and furniture manufacturers to obtain users' perceived usability evaluation of seating during the design process while the actual context is absent.

Emergency Physicians' Workstation Design: An Observational Study of Interruptions and Perception of Collaboration During Shift-End Handoffs.

BACKGROUND: Frequent external interruptions and lack of collaboration among team members are known to be common barriers in end-of-shift handoffs between physicians in the emergency department. In spite of being the primary location for this crucial and cognitively demanding task, workstations are not designed to limit barriers and support handoffs. OBJECTIVE: The purpose of this study is to examine handoff characteristics, actual and perceived interruptions, and perceived collaboration among emergency physicians performing end-of-shift handoffs in physician workstations with varying levels of enclosures-(a) open-plan workstation, (b) enclosed workstation, and (c) semi-open workstation. METHOD: Handoff and interruption characteristics were captured through in-person observations of 60 handoffs using an iPad-based tool. Additionally, physicians participating in the handoffs responded to a survey pertaining to their perception of interruptions and collaboration with clinicians during each phase. Other organizational and demographic data were obtained from the hospital database, surveys, and observations. RESULTS: Physicians working in the open workstation experienced a significantly higher number of interruptions/hour (18.08 int/hr) as compared to the semi-open (13.62 int/hr) and enclosed workstations (11.41 int/hr). Most physicians perceived that they were interrupted in the semi-open and open workstations. In addition, majority of physicians in the enclosed pod perceived high collaboration with clinicians involved in and present in the workstation during handoff. CONCLUSION: This correlational study showed positive outcomes experienced by physician working in the enclosed workstation as compared to the open and semi-open workstations.

Understanding Key Home and Community Environment Challenges Encountered by Older Adults Undergoing Total Knee or Hip Arthroplasty.

BACKGROUND AND OBJECTIVES: Older adults undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) experience significant challenges while navigating their homes after surgery and are at higher risk for falls and injuries. This study explored the specific home and community physical environment challenges faced by community-dwelling older adults while performing daily activities and actions taken to modify their homes before surgery. RESEARCH DESIGN AND METHODS: Using a qualitative descriptive methodology, semistructured interviews were conducted with 22 older adult-care partner dyads pre- and postsurgery to identify key built environment barriers and facilitators in addition to home modifications made pre- and postsurgery. RESULTS: Challenges anticipated by participants to perform daily activities presurgery varied from those experienced postsurgery. Lack of support along stairs or in bathrooms, flooring material, and transitions were significant concerns raised by the participants before surgery. Size and layout of home and ergonomics of resting furniture were recognized as issues postsurgery. Modifications ranged from easy fixes such as rearranging furniture, removing clutter, and installing grab bars to high-cost structural changes such as remodeling critical spaces such as bathrooms. Although participants agreed on the importance of conducting proactive home assessments and modifications before surgery, perceived costs and lack of knowledge or services limit older adults from implementing some changes. DISCUSSION AND IMPLICATIONS: Home modifications must be considered proactively before an event such as a THA or TKA. These should be done within the context of the specific needs, abilities, financial capabilities, and social and physical home environments of the individual and the residential caregivers.

Evaluating Care Partner Preferences for Seating in an Outpatient Surgery Waiting Area Using Virtual Reality.

OBJECTIVE: The purpose of this study was to examine the factors impacting seating choices of care partners while conducting common tasks in an outpatient surgical center waiting room. BACKGROUND: Waiting rooms in healthcare environments have been previously studied to understand how factors such as aesthetics, privacy, comfort, and positive distractions impact user perception of quality of care. Although care partners of patients often spend long hours in the surgical waiting rooms, no studies have addressed users' seat type and location preferences in waiting areas. METHODS: In this study, 92 participants made seat selections while performing scenario-based tasks in a virtual waiting area. A mixed-methods approach including a survey and semi-structured interviews was utilized to capture participants' feedback on how certain factors (e.g., visibility, accessibility, privacy, comfort, and aesthetic quality) impacted their choices. RESULTS: The optimal seat location and type in the waiting area varied depending on the type of task care partners were engaged in. While being able to sit with their loved one was the most important factor influencing seat selection during patient check-in, seat location was the most important factor in all other scenarios. The importance of factors such as seat comfort, seat type, visual and auditory privacy, and visibility to registration area varied across scenarios. However, the visual appearance of the seating remained equally important across all scenarios. CONCLUSIONS: The use of different scenarios allowed users to identify their preferences regarding seating within the context of their specific needs at different points in the waiting process.