A pilot study of non-routine events in gynecological surgery: Type, impact, and effect.

OBJECTIVE: Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surgeries. METHODS: Observational data were collected prospectively within one surgical gynecology department over a five month period. Researchers captured NREs in real time using a validated tablet PC-based tool according to the NRE type, impact, whom was affected, and duration. Researchers also noted what surgical approach (i.e. open, laparoscopic, robotic) was used. RESULTS: Across 45 surgical cases, 554 non-routine events (M = 12.31 NREs per case, SD = 9.81) were identified. The majority of non-routine events were external interruptions (40.3%), teamwork (26.7%), or equipment (21.3%). The circulating nurse was most frequently affected by NREs (43.2%) followed by the entire surgical team (13.7%). There was no statistically significant difference in non-routine events based on surgical approach. CONCLUSION: Non-routine events are prevalent in the gynecological surgical setting. Identifying the sociotechnical factors that influence non-routine events are important in determining interventions that will combat the associated risks. Interventions focusing on teamwork, managing external interruptions, and coordinating equipment may have the greatest impact to reduce or eliminate NREs in gynecological surgeries.

Nonconscious activation of an elderly stereotype and speed of driving.

Under the guise of evaluating a head-up display in a driving simulator, 11 participants (5 men), ages 21 to 35 years, completed scrambled-sentence tasks (while waiting at stop signs) designed to prime an elderly stereotype. Each driver completed both the Elderly Stereotype and Control conditions with order counterbalanced across participants. Further, order of presentation of word sets for each trial was random. Driving speed and driving time between stop signs in the Elderly Stereotype condition were compared to the Control condition in which nonspecific age words were substituted for elderly stereotyped words. Participants showed lower maximum speed and longer driving time in the Elderly Stereotype condition than in the Control condition, even though participants reported no awareness of the theme in the experimental condition.

Characteristics of team briefings in gynecological surgery.

Preoperative briefings have been proven beneficial for improving team performance in the operating room. However, there has been minimal research regarding team briefings in specific surgical domains. As part of a larger project to develop a briefing structure for gynecological surgery, the study aimed to better understand the current state of pre-operative team briefings in one department of an academic hospital. Twenty-four team briefings were observed and video recorded. Communication was analyzed and social network metrics were created based on the team member verbal interactions. Introductions occurred in only 25% of the briefings. Network analysis revealed that average team briefings exhibited a hierarchical structure of communication, with the surgeon speaking the most frequently. The average network for resident-led briefings displayed a non-hierarchical structure with all team members communicating with the resident. Briefings conducted without a standardized protocol can produce variable communication between the role leading and the team members present.

Bridging psychology and engineering to make technology work for people.

Engineering grand challenges and big ideas not only demand innovative engineering solutions, but also typically involve and affect human thought, behavior, and quality of life. To solve these types of complex problems, multidisciplinary teams must bring together experts in engineering and psychological science, yet fusing these distinct areas can be difficult. This article describes how Human Systems Engineering (HSE) researchers have confronted such challenges at the interface of humans and technological systems. Two narrative cases are reported-computer game-based cognitive assessments and medical device reprocessing-and lessons learned are shared. The article then discusses 2 strategies currently being explored to enact such lessons and enhance these kinds of multidisciplinary engineering teams: a "top-down" administrative approach that supports team formation and productivity through a university research center, and a "bottom-up" engineering education approach that prepares students to work at the intersection of psychology and engineering. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Human Factors in Medical Device Design: Methods, Principles, and Guidelines.

A total of 400,000 to 500,000 patients die in intensive care units (ICUs) each year, largely because ICUs care for the sickest patients. On the other hand, factors such as workload, shift changes, handoffs, alarm fatigue, inadequate team communication, and difficult-to-use medical devices contribute to the problem. This article focuses on the human factors of those medical devices, a significant cause of adverse events in the ICU.

Better instructions for use to improve reusable medical equipment (RME) sterility.

OBJECTIVE: The objective was to evaluate human-factors-based instructional aids on endoscope reprocessing. BACKGROUND: The project stems from recent failures in reprocessing (cleaning) endoscopes, contributing to the spread of harmful bacterial and viral agents between patients. A previous study discovered three themes that represent a majority of problems: (1) lack of visibility (parts and tools were difficult to identify), (2) high memory demands, and (3) insufficient feedback. METHOD: In an effort to improve completion rate and reduce error, the authors designed instructional aids utilizing human factors principles that would replace existing manufacturer-provided visual aids. Then, they conducted a usability test, which compared the endoscope reprocessing performance of novices using the standard manufacturer-provided visual aids and the new instructional aids. RESULTS: Participants in the experimental group successfully completed 87.1% of the reprocessing procedure with the use of the instructional aids, compared to 44.7% in the control group using only existing support materials. Of 60 subtasks, 27 showed significant improvement in completion rates. CONCLUSION: When given an instructional aid designed with human factors principles, participants were able to more successfully complete the reprocessing task. This resulted in an endoscope that was more likely to be safe for use on patients. APPLICATION: The human factors design elements utilized to create the instructional aids could be transferred to a dynamic electronic-based system to improve patient safety.

Using knowledge structures to redesign an instructor-operator station.

Frequently, user interface (UI) designers must choose between modifying an established, but suboptimal and familiar, UI or to avoid such changes. Changing the UI's, organization may frustrate users who have become familiar with the original design, whereas failing to make changes may force users to perform at an unsatisfactory level. This paper presents two studies that investigate whether users familiar with a poorly designed UI would find items faster, and prefer a reorganized UI that conformed to domain expert knowledge, or would their familiarity with the original UI yield faster performance and higher satisfaction. This paper describes activities to redesign a menu structure in a simulator instructor-operator station (IOS) using hierarchical card sorting and cluster analysis (Romesburg, 2004). This analysis was used to reorganize the menu structure to reflect the knowledge representations of domain experts in accordance with the principle of proximity compatibility (Wickens and Carswell, 1995; Rothrock et al., 2006). The new design was validated with a separate set of users by a reaction time experiment and preference selection.

Feedback preferences and impressions of waiting.

OBJECTIVE: Three experiments examined the effects of various feedback displays on user preference, apparent waiting durations, waiting time reasonableness, and other user experience measures. BACKGROUND: User interface guidelines advocate keeping users informed about system status; however, the duration estimation literature shows that focusing on temporal information makes the wait seem longer. How can designers reconcile these issues? METHODS: In three experiments, students chose movies from a simulated movie database and then were shown feedback displays (static, sequential dots, constant-rate progress bars, or variable-rate progress bars) for different durations. Users judged how reasonable the wait was and how long it lasted and then ranked their preference for the dialogs. RESULTS: The pattern of preference results was different from duration-related judgments. Users preferred feedback that provided more information. On the other hand, when judging duration, users perceived simpler interfaces as being most reasonable. CONCLUSION: Different types of feedback are required for reducing perceived wait and increasing preference. Ratings of wait time reasonableness were consistent with the attentional gate theory of prospective timing; attention-demanding activity caused the wait to seem less reasonable. Preference, on the other hand, requires keeping users informed about the progress of operations. APPLICATION: Users prefer more feedback rather than less, even if it makes the wait seem less reasonable. However, the constant progress bar performed at the top of both reasonableness and preference, keeping users informed without increasing arousal or focusing attention on temporal stimuli. Other options are also discussed to make duration perceptions more reasonable.