Utilizing a Human Factors Nursing Worksystem Improvement Framework to Increase Nurses' Time at the Bedside and Enhance Safety.

OBJECTIVE: The aim of this study is to increase nurses' time for direct patient care and improve safety via a novel human factors framework for nursing worksystem improvement. BACKGROUND: Time available for direct patient care influences outcomes, yet worksystem barriers prevent nurses adequate time at the bedside. METHODS: A novel human factors framework was developed for worksystem improvement in 3 units at 2 facilities. Objectives included improving nurse efficiency as measured by time-and-motion studies, reducing missing medications and subsequent trips to medication rooms and improving medication safety. RESULTS: Worksystem improvement resulted in time savings of 16% to 32% per nurse per 12-hour shift. Requests for missing medications dropped from 3.2 to 1.3 per day. Nurse medication room trips were reduced by 30% and nurse-reported medication errors fell from a range of 1.2 to 0.8 and 6.3 to 4.0 per month. CONCLUSIONS: An innovative human factors framework for nursing worksystem improvement provided practical and high priority targets for interventions that significantly improved the nursing worksystem.

Human factors engineering approaches to patient identification armband design.

The task of patient identification is performed many times each day by nurses and other members of the care team. Armbands are used for both direct verification and barcode scanning during patient identification. Armbands and information layout are critical to reducing patient identification errors and dangerous workarounds. We report the effort at two large, integrated healthcare systems that employed human factors engineering approaches to the information layout design of new patient identification armbands. The different methods used illustrate potential pathways to obtain standardized armbands across healthcare systems that incorporate human factors principles. By extension, how the designs have been adopted provides examples of how to incorporate human factors engineering into key clinical processes.

The effect of defaults in an electronic health record on laboratory test ordering practices for pediatric patients.

OBJECTIVE: Defaults have been shown to impact decision making in a variety of domains. However, no research has applied defaults to medical care decisions utilizing an Electronic Health Record (EHR). This research was designed to examine how providers' inpatient laboratory ordering practices were influenced by default selections in EHR order sets. METHOD: Providers were asked to complete inpatient admission orders for six fictitious pediatric patients using three EHR interface designs: opt-in (no laboratory tests preselected), opt-out (all laboratory tests preselected), or recommended (only laboratory tests recommended by pediatric experts preselected). EHR design was manipulated within subjects. Seventy-two providers from a Midwestern pediatric hospital reviewed the six cases and completed admission orders for all cases, entering two cases with each EHR design. Order of the cases and EHR designs were counterbalanced across participants. RESULTS: When all laboratory tests were preselected, providers ordered significantly more tests and increased the cost of admission by more than $70 when compared with the opt-in, p < .01, and recommended EHR designs, p < .01. Furthermore, providers ordered more tests recommended by the pediatric experts when using the recommended design than when using the opt-in design, p = .03, although the total number of tests ordered did not differ significantly, p = .97. CONCLUSIONS: This study demonstrated that default selections in an EHR can significantly influence providers' laboratory test ordering practices and that hospital systems could benefit from adding expert-recommended defaults to EHR order sets.

Why do patients derogate physicians who use a computer-based diagnostic support system?

OBJECTIVE: To better understand 1) why patients have a negative perception of the use of computerized clinical decision support systems (CDSSs) and 2) what contributes to the documented heterogeneity in the evaluations of physicians who use a CDSS. METHODS: Three vignette-based studies examined whether negative perceptions stemmed directly from the use of a computerized decision aid or the need to seek external advice more broadly (experiment 1) and investigated the contributing role of 2 individual difference measures, attitudes toward statistics (ATS; experiment 2) and the Multidimensional Health Locus of Control Scale (MHLC; experiment 3), to these findings. RESULTS: A physician described as making an unaided diagnosis was rated significantly more positively on a number of attributes than a physician using a computerized decision aid but not a physician who sought the advice of an expert colleague (experiment 1). ATS were unrelated to perceptions of decision aid use (experiment 2); however, greater internal locus of control was associated with more positive feelings about unaided care and more negative feelings about care when a decision aid was used (experiment 3). CONCLUSION: Negative perceptions of computerized decision aid use may not be a product of the need to seek external advice more generally but may instead be specific to the use of a nonhuman tool and may be associated with individual differences in locus of control. Together, these 3 studies may be used to guide education efforts for patients.

Does content affect whether users remember that Web pages were hyperlinked?

OBJECTIVE: We determined whether memory for hyperlinks improved when they represented relations between the contents of the Web pages. BACKGROUND: J. S. Farris (2003) found that memory for hyperlinks improved when they represented relations between the contents of the Web pages. However, Farris's (2003) participants could have used their knowledge of site content to answer questions about relations that were instantiated via the site's content and its hyperlinks. METHOD: In Experiment 1, users navigated a Web site and then answered questions about relations that were instantiated only via content, only via hyperlinks, and via content and hyperlinks. Unlike Farris (2003), we split the latter into two sets. One asked whether certain content elements were related, and the other asked whether certain Web pages were hyperlinked. Experiment 2 replicated Experiment 1 with one modification: The questions that were asked about relations instantiated via content and hyperlinks were changed so that each question's wrong answer was also related to the question's target. RESULTS: Memory for hyperlinks improved when they represented relations instantiated within the content of the Web pages. This was true when (a) questions about content and hyperlinks were separated (Experiment 1) and (b) each question's wrong answer was also related to the question's target (Experiment 2). CONCLUSION: The accuracy of users' mental representations of local architecture depended on whether hyperlinks were related to the site's content. APPLICATION: Designers who want users to remember hyperlinks should associate those hyperlinks with content that reflects the relation between the contents on the Web pages.