Development and Evaluation of a Metric-based Clinical Simulation Procedure for Assessing Ostomy Care in Nursing Practice.

Background: There is a need to understand the clinical decision-making and work practices within ostomy nursing care to support expanding nursing training. Objective: To develop and evaluate a new metric-based simulation for assessing ostomy nursing care using a human factors approach. Sample: This pilot study involved eleven stakeholders in the needs assessment, six nurse participants performing simulated ostomy care, and three independent observers assessing procedure reliability. Method: We conducted a needs assessment of ostomy nursing care and training, developed an enhanced metric-based simulation for ostomy appliance change procedures, and statistically evaluated its reliability for measuring the simulated tasks. Results: The enhanced metric-based simulation captured different tasks within four task categories: product selection; stoma and peristomal skin care; baseplate sizing and adhesion; and infection control strategies. The video review procedure was reliable for assessing continuous (average ICC≥0.96) and categorical (average κ>0.96) variables. Conclusion: The new metric-based simulation was suitable for characterizing a broad range of clinical decision-making and work practices in ostomy nursing care.

The movement of syringes and medication during anesthesiology delivery: An observational study in laparoscopic surgeries.

The movements of syringes and medications during an anesthetic case have yet to be systematically documented. We examine how syringes and medication move through the anesthesia work area during a case. We conducted a video-based observational study of 14 laparoscopic surgeries. We defined 'syringe events' as when syringe was picked up and moved. Medications were administered to the patient in only 48 (23.6%) of the 203 medication or syringe events. On average, 14.5 syringe movements occurred in each case. We estimate approximately 4.2 syringe movements for each medication administration. When a medication was administered to the patient (either through the IV pump or the patient port), it was picked up from one of 8 locations in the work area. Our study suggests that the syringe storage locations vary and include irregular locations (e.g., patient bed or provider's pockets). Our study contributes to understanding the complexity in the anesthesia work practices.

Examining how information presentation methods and a chatbot impact the use and effectiveness of electronic health record patient portals: An exploratory study.

OBJECTIVES: Examining information presentation strategies that may facilitate patient education through patient portals is important for effective health education. METHODS: A randomized exploratory study evaluated information presentation (text or videos) and a chatbot in patient education and examined several performance and outcome variables (e.g., search duration, Decisional Conflict Scale, and eye-tracking measures), along with a simple descriptive qualitative content analysis of the transcript of chatbot. RESULTS: Of the 92 participants, those within the text conditions (n = 46, p < 0.001), had chatbot experiences (B =-74.85, p = 0.046), knew someone with IBD (B =-98.66, p = 0.039), and preferred to engage in medical decision-making (B =102.32, p = 0.006) were more efficient in information-searching. Participants with videos spent longer in information-searching (mean=666.5 (SD=171.6) VS 480.3 (SD=159.5) seconds, p < 0.001) but felt more informed (mean score=18.8 (SD=17.6) VS 27.4 (SD=18.9), p = 0.027). The participants' average eye fixation duration with videos was significantly higher (mean= 473.8 ms, SD=52.9, p < 0.001). CONCLUSIONS: Participants in video conditions were less efficient but more effective in information seeking. Exploring the trade-offs between efficiency and effectiveness for user interface designs is important to appropriately deliver education within patient portals. PRACTICE IMPLICATIONS: This study suggests that user interface designs and chatbots impact health information's efficiency and effectiveness.

Redefining the human factors approach to 3D gestural HCI by exploring the usability-accuracy tradeoff in gestural computer systems.

3D gestural technology for HCI could transform the way people interact with computing systems. There are traditionally two approaches to developing gestural technology systems: a human-based approach where usability is maximized and a technology-based approach where system accuracy is maximized. The tradeoff between usability and accuracy may negatively affect the overall trust and reliability in the system. Therefore, this study seeks to redefine the human-based approach to gestural system development by introducing a bottom-up approach to identifying the lower-level features that produce a gesture, thus allowing the technology to accurately recognize features. A user elicitation study was performed, and gestures were classified according to a novel feature extraction gesture taxonomy and a traditional taxonomy of classifying gestures as a unit. The feature-extraction approach revealed several advantages because it fosters a bottom-up approach to identifying gesture features. Using this approach may mitigate the effects of the usability-accuracy tradeoff in gestural system development.

Improving safety in the operating room: Medication icon labels increase visibility and discrimination.

Misreading labels, syringes, and ampoules is reported to make up a 54.4% of medication administration errors. The addition of icons to medication labels in an operating room setting could add additional visual cues to the label, allowing for improved discrimination, visibility, and easily processed information that might reduce medication administration errors. A multi-disciplinary team proposed a method of enhancing visual cues and visibility of medication labels applied to vasoactive medication infusions by adding icons to the labels. Participants were 1.12 times more likely to correctly identify medications from farther away (p < 0.001, AOR = 1.12, 95% CI: 1.02, 1.22) with icons. When icons were present, participants were 2.16 times more likely to be more confident in their identifications (p < 0.001, AOR = 2.16, 95%CI: 1.80, 2.57). Carefully designed icons may offer an additional method for identifying medications, and thus reducing medication administration errors.

Medication errors, critical incidents, adverse drug events, and more: a review examining patient safety-related terminology in anaesthesia.

Literature focused on quantifying or reducing patient harm in anaesthesia uses a variety of labels and definitions to represent patient safety-related events, such as 'medication errors', 'adverse events', and 'critical incidents'. This review extracts and compares definitions of patient safety-related terminology in anaesthesia to examine the scope of this variability and inconsistencies. A structured review was performed in which 36 of the 769 articles reviewed met the inclusion criteria. Similar terms were grouped into six categories by similarities in keyword choice (Adverse Event, Critical Incident, Medication Error, Error, Near Miss, and Harm) and their definitions were broken down into three base components to allow for comparison. Our analysis found that the Medication Error category, which encompasses the greatest number of terms, had widely variant definitions which represent fundamentally different concepts. Definitions of terms within the other categories consistently represented relatively similar concepts, though key variations in wording remain. This inconsistency in terminology can lead to problems with synthesising, interpreting, and overall sensemaking in relation to anaesthesia medication safety. Guidance towards how 'medication errors' should be defined is provided, yet a definition will have little impact on the future of patient safety without organisations and journals taking the lead to promote, publish, and standardise definitions.

Observational study of anaesthesia workflow to evaluate physical workspace design and layout.

BACKGROUND: The safety and efficiency of anaesthesia care depend on the design of the physical workspace. However, little is known about the influence that workspace design has on the ability to perform complex operating theatre (OT) work. The aim of this study was to observe the relationship between task switching and physical layout, and then use the data collected to design and assess different anaesthesia workspace layouts. METHODS: In this observational study, six videos of anaesthesia providers were analysed from a single centre in the United States. A task analysis of workflow during the maintenance phase of anaesthesia was performed by categorising tasks. The data supported evaluations of alternative workspace designs. RESULTS: An anaesthesia provider's time was occupied primarily by three tasks: patient (mean: 30.0% of total maintenance duration), electronic medical record (26.6%), and visual display tasks (18.6%). The mean time between task switches was 6.39 s. With the current workspace layout, the anaesthesia provider was centred toward the patient for approximately half of the maintenance duration. Evaluating the alternative layout designs showed how equipment arrangements could improve task switching and increase the provider's focus towards the patient and visual displays. CONCLUSIONS: Our study showed that current operating theatre layouts do not fit work demands. We report a simple method that facilitates a quick layout design assessment and showed that the anaesthesia workspace can be improved to better suit workflow and patient care. Overall, this arrangement could reduce anaesthesia workload while improving task flow efficiency and potentially the safety of care.

Online Health Resource Use by Individuals With Inflammatory Bowel Disease: Analysis Using the National Health Interview Survey.

BACKGROUND: The internet has enabled convenient and efficient health information searching which is valuable for individuals with chronic conditions requiring some level of self-management. However, there is little research evaluating what factors may impact the use of the internet for health-related tasks for specific clinical populations, such as individuals with inflammatory bowel diseases. OBJECTIVE: Our goal was to investigate the factors that influence internet use in acquiring health information by individuals with inflammatory bowel diseases. Specifically, we identified factors associated with internet searching behavior and using the internet for completing health-related tasks. METHODS: We used 2016 National Health Interview Survey weighted data to develop logistic regression models to predict the likelihood that individuals with inflammatory bowel diseases would use the internet for 2 types of tasks: seeking health information through online searches and using the internet to perform health-related tasks including scheduling appointments and emailing care providers. RESULTS: 2016 National Health Interview Survey weighted data include more than 3 million weighted adult respondents with inflammatory bowel diseases (approximately 1.29% of adults in the weighted data set). Our results suggest that approximately 66.3% of those with inflammatory bowel diseases reported using the internet at least once a day, and approximately 14.7% reported being dissatisfied with their current health care. About 62.3% of those with inflammatory bowel diseases reported that they had looked up health information online, 16.3% of those with inflammatory bowel diseases reported that they had scheduled an appointment with a health care provider online, and 21.6% reported having used a computer to communicate with a health provider by email. We found that women who were self-regulating their care were more likely to look up health information online than others. Both middle-aged and older adults with inflammatory bowel diseases who were unsatisfied with their current health care were less likely to look up health information online. Frequent internet users who were worried about medical costs were more likely to look up health information online. Similarly, the results from our statistical models suggest that individuals with inflammatory bowel diseases who were frequent internet users were more likely to use the internet for specific health-related tasks. Additionally, women with inflammatory bowel diseases who reported being married were less likely to use the internet for specific health-related tasks. CONCLUSIONS: For those with inflammatory bowel diseases, there are additional socioeconomic and behavioral factors that impact the use of the internet for health information and health-related tasks. Future research should evaluate how these factors moderate the use of the internet and identify how online resources can support clinical populations in ways that improve access to information, support health self-management, and subsequently improve health outcomes.

Skin Preparation and Electrode Replacement to Reduce Alarm Fatigue in a Community Hospital Intensive Care Unit.

BACKGROUND: Nurses in intensive care units are exposed to hundreds of alarms during a shift, and research shows that most alarms are not clinically relevant. Alarm fatigue can occur when a nurse becomes desensitized to alarms. Alarm fatigue can jeopardize patient safety, and adverse alarm events can lead to patients dying. OBJECTIVE: To evaluate how a process intervention affects the number of alarms during an 8-hour shift in an intensive care unit. METHODS: A total of 62 patients from an intensive care unit were included in the study; 32 of these patients received the intervention, which included washing the patient's chest with soap and water and applying new electrocardiography electrodes at the start of a shift. The number of alarms, clinical diagnoses, and demographic variables were collected for each patient. A Poisson regression model was used to evaluate the impact of the intervention on the overall number of clinical alarms during the shift, with no adjustments to the alarm settings or other interventions. RESULTS: After relevant covariates are controlled for, the results suggest that patients in the intervention group presented significantly fewer alarms than did patients in the control group. CONCLUSIONS: Managing clinical alarms is a main issue in terms of both patient safety and staff workload management. The results of this study demonstrate that a relatively simple process-oriented strategy can decrease the number of alarms.

Learning in simulated environments: An assessment of 4-week retention outcomes.

Simulations offer the benefits of a safer and more accessible learning environment, where learners can practice until the point of proficiency. While research into the effectiveness of simulations as learning tools has found tangible benefits, fewer studies have examined retention and differences between high and low fidelity simulations. This research sought to supplement the literature in this domain by investigating whether participants who learned to construct an electrical circuit using a 2D or 3D breadboard simulation could achieve comparable learning, transfer, and retention outcomes to those who learned using a physical breadboard. The influence of learner characteristics - cognitive ability and goal orientation - were also evaluated. This study had two parts: a cross-sectional portion that examined learning and transfer outcomes and a longitudinal portion that examined retention outcomes after a 2 and 4-week period. The cross-sectional analysis included 70 participants and the longitudinal analysis included 40 participants. The results found that the physical fidelity of the learning environment significantly impacted several transfer outcomes (construction and construction time) but not retention outcomes. Cognitive ability was a significant predictor of learning (gain score, circuit design score) and retention (posttest scores, construction time) outcomes. Learning goal orientation significantly predicted circuit construction over time and measurement occasion significantly predicted posttest scores and interacted with fidelity to predict circuit design score. The study demonstrated that simulated environments can lead to comparable, or better, proficiency than physical environments. These findings have implications for the design and implementation of simulated environments, specifically for courses delivered in an online setting.

Using a systems approach to evaluate a circulating nurse's work patterns and workflow disruptions.

The physical environment affects how work is done in operating rooms (OR). The circulating nurse (CN), in particular, requires access to and interacts with materials, equipment, and technology more than other OR team members. Naturalistic study of CN behavior is therefore valuable in assessing how OR space and physical configuration influences work patterns and disruptions. This study evaluated the CNs' work patterns and flow disruptions (FD) by analyzing 25 surgeries across three different ORs. The OR layouts were divided into transitional and functional zones, and the work of CNs was categorized into patient, equipment, material, and information tasks. The results reveal that information tasks involve less movement than other types of work, while across all ORs, CNs were more likely to be involved in layout and environmental hazard FDs when involved in patient, material, or equipment-related tasks compared to information tasks. Different CN work patterns and flow disruptions between ORs suggest a link between OR layout and a CN's work. Future studies should examine how specific layout elements influence outcomes.

Developing a 3D Gestural Interface for Anesthesia-Related Human-Computer Interaction Tasks Using Both Experts and Novices.

OBJECTIVE: The purpose of this research was to compare gesture-function mappings for experts and novices using a 3D, vision-based, gestural input system when exposed to the same context of anesthesia tasks in the operating room (OR). BACKGROUND: 3D, vision-based, gestural input systems can serve as a natural way to interact with computers and are potentially useful in sterile environments (e.g., ORs) to limit the spread of bacteria. Anesthesia providers' hands have been linked to bacterial transfer in the OR, but a gestural input system for anesthetic tasks has not been investigated. METHODS: A repeated-measures study was conducted with two cohorts: anesthesia providers (i.e., experts) ( N = 16) and students (i.e., novices) ( N = 30). Participants chose gestures for 10 anesthetic functions across three blocks to determine intuitive gesture-function mappings. Reaction time was collected as a complementary measure for understanding the mappings. RESULTS: The two gesture-function mapping sets showed some similarities and differences. The gesture mappings of the anesthesia providers showed a relationship to physical components in the anesthesia environment that were not seen in the students' gestures. The students also exhibited evidence related to longer reaction times compared to the anesthesia providers. CONCLUSION: Domain expertise is influential when creating gesture-function mappings. However, both experts and novices should be able to use a gesture system intuitively, so development methods need to be refined for considering the needs of different user groups. APPLICATION: The development of a touchless interface for perioperative anesthesia may reduce bacterial contamination and eventually offer a reduced risk of infection to patients.

The Impact of Operating Room Layout on Circulating Nurse's Work Patterns and Flow Disruptions: A Behavioral Mapping Study.

AIM: To assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions. BACKGROUND: The CN plays a significant role in promoting patient safety during surgical procedures by observing, monitoring, and managing potential threats at and around the surgical field. Their work requires constant movement to different parts of the OR to support team members. The layout of the OR and crowded and cluttered environment might impact the CN's workflow and cause disruptions during the surgery. METHOD: A convenience sample of 25 surgeries were video recorded and thematically coded for CN's activities, locations, and flow disruptions. The OR layout was categorized into transitional zones and functional zones (workstations, supply zones, support zones, and sterile areas around the surgical table). CN's activities were classified into patient-, equipment-, material-, and information-related activities. Flow disruptions included those related to environmental hazards and layout. RESULTS: The CN traveled through multiple zones during 91% of the activities. The CN's workstation acted as a main hub from which the CN made frequent trips to both sides of the surgical table, the foot of the OR table, supply zones, and support zones. Transitional zones accounted for 58.3% of all flow disruption that the CN was involved in whereas 28% occurred in areas surrounding the OR bed. CONCLUSION: The similarity of the movement and flow disruption patterns, despite variations in OR layout, highlighted the adjacencies required between major zones that CNs regularly visit. These optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.

Modelling and forecasting daily surgical case volume using time series analysis.

Hospitals and outpatient surgery centres are often plagued by a recurring staff management question: "How can we plan our nursing schedule weeks in advance, not knowing how many and when patients will require surgery?" Demand for surgery is driven by patient needs, physician constraints, and weekly or seasonal fluctuations. With all of these factors embedded into historical surgical volume, we use time series analysis methods to forecast daily surgical case volumes, which can be extremely valuable for estimating workload and labour expenses. Seasonal Autoregressive Integrated Moving Average (SARIMA) modelling is used to develop a statistical prediction model that provides short-term forecasts of daily surgical demand. We used data from a Level 1 Trauma Centre to build and evaluate the model. Our results suggest that the proposed SARIMA model can be useful for estimating surgical case volumes 2-4 weeks prior to the day of surgery, which can support robust and reliable staff schedules.

Assessing drivers' response during automated driver support system failures with non-driving tasks.

INTRODUCTION: With the increase in automated driver support systems, drivers are shifting from operating their vehicles to supervising their automation. As a result, it is important to understand how drivers interact with these automated systems and evaluate their effect on driver responses to safety critical events. This study aimed to identify how drivers responded when experiencing a safety critical event in automated vehicles while also engaged in non-driving tasks. METHOD: In total 48 participants were included in this driving simulator study with two levels of automated driving: (a) driving with no automation and (b) driving with adaptive cruise control (ACC) and lane keeping (LK) systems engaged; and also two levels of a non-driving task (a) watching a movie or (b) no non-driving task. In addition to driving performance measures, non-driving task performance and the mean glance duration for the non-driving task were compared between the two levels of automated driving. RESULTS: Drivers using the automated systems responded worse than those manually driving in terms of reaction time, lane departure duration, and maximum steering wheel angle to an induced lane departure event. These results also found that non-driving tasks further impaired driver responses to a safety critical event in the automated system condition. CONCLUSION: In the automated driving condition, driver responses to the safety critical events were slower, especially when engaged in a non-driving task. PRACTICAL APPLICATION: Traditional driver performance variables may not necessarily effectively and accurately evaluate driver responses to events when supervising autonomous vehicle systems. Thus, it is important to develop and use appropriate variables to quantify drivers' performance under these conditions.

Applied Use of Safety Event Occurrence Control Charts of Harm and Non-Harm Events: A Case Study.

Most hospitals use occurrence reporting systems that facilitate identifying serious events that lead to root cause investigations. Thus, the events catalyze improvement efforts to mitigate patient harm. A serious limitation is that only a few of the occurrences are investigated. A challenge is leveraging the data to generate knowledge. The goal is to present a methodology to supplement these incident assessment efforts. The framework affords an enhanced understanding of patient safety through the use of control charts to monitor non-harm and harm incidents simultaneously. This approach can identify harm and non-harm reporting rates and also can facilitate monitoring occurrence trends. This method also can expedite identifying changes in workflow, processes, or safety culture. Although unable to identify root causes, this approach can identify changes in near real time. This approach also supports evaluating safety or policy interventions that may not be observable in annual safety climate surveys.