Using Virtual Reality (VR) Mock-Ups for Evidence-Based Healthcare Facility Design Decisions.

(1) Background: There are many complexities and trade-offs that design teams consider when designing or renovating a built environment for healthcare. Virtual reality (VR) mock-ups can allow design teams to evaluate the planned design. This study aimed to examine the overall value of using VR mock-ups to conduct a simulation-based mock-up evaluation. (2) Methods: Data collected from scenario enactments within a VR mock-up was compared to data collected from an existing medication room with the same design to assess predictive validity. Outcomes regarding quality and patient safety were also examined as a result of design modifications to the VR mock-up which were identified through a post-occupancy evaluation (POE) of the existing medication room. Survey data from participants, hospital design stakeholders, and POE recommendation recipients captured perceptions regarding the evaluation process. Specifically, this included perceptions regarding mock-up and scenario realism as well as utility of the evaluation process. (3) Results: Evidence-based data collected using the VR mock-up accurately assessed workflow (link analysis), bumps, impediments, interruptions, and task completion times. Collecting data pertaining to selection errors and equipment placement were identified after procuring the VR software and therefore the accuracy of these measures was not assessed. Searching behaviours were not possible to capture using the VR software. A 506% return on investment was achieved through the VR mock-up evaluations. (4) Conclusion: Organizations should consider what evaluation objectives are planned and how they will be measured for a mock-up evaluation to determine if VR is appropriate.

Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room.

PURPOSE: The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. BACKGROUND: Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. METHODS: A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. RESULTS: The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

Goals, Recommendations, and the How-To Strategies for Developing and Facilitating Patient Safety and System Integration Simulations.

PURPOSE: The aim of this article is to outline overall goals, recommendations, and provide practical How-To strategies for developing and facilitating patient safety and system integration (PSSI) simulations for healthcare team members and organizations. BACKGROUND: Simulation is increasingly being used as a quality improvement tool to better understand the tasks, environments, and processes that support the delivery of healthcare services. These PSSI simulations paired with system-focused debriefing can occur prior to implementing a new process or workflow to proactively identify system issues. They occur as part of a continuous cycle of quality improvement and have unique considerations for planning, implementation, and delivery of healthcare. METHOD: The Delphi technique was used to develop the recommendations and How-To strategies to guide those interested in conducting a PSSI simulations. The Delphi technique is a structured communication technique and systematic process of gathering information from a group of identified experts through a series of questionnaires to gain consensus regarding judgments on complex processes, where precise information is not available in the literature. The Delphi technique permitted an iterative and multistaged approach to transform expert opinions into group consensus. RESULTS: The goals, recommendations, and How-To strategies include a focus on project management, stakeholder engagement, sponsorship, scenario design, prebriefing and debriefing, and evaluation metrics. The intent is to proactively identify system issues and disseminate actionable findings. CONCLUSIONS: This article highlights salient features to consider when using simulation as a strategy and tool for patient safety and quality improvement.

Simulation-Based Mock-Up Evaluation of a Universal Operating Room.

Designing or renovating a physical environment for healthcare is a complex process and is critical for both the staff and the patients who rely on the environment to support and facilitate patient care. Conducting a simulation-based mock-up evaluation as part of the design process can enhance patient safety, staff efficiency, as well as user experience, and can yield financial returns. A large urban tertiary care center located in Vancouver, Canada followed a framework to evaluate the proposed design template for 28 universal operating rooms (ORs) included within the OR Renewal Project scope. Simulation scenarios were enacted by nursing staff, surgeons, anesthesiologists, residents, radiology techs, and anesthesia assistants. Video and debriefing data were used to conduct link analyses, as well as analyses of observed behaviors including congestions and bumps to generate recommendations for evidence-based design changes that were presented to the project team. Recommendations incorporated into the design included relocating doors, booms, equipment, and supplies, as well as reconfigurations to workstations. These recommendations were also incorporated into the mock-up and retested to iteratively develop and evaluate the design. Findings suggest that incorporating the recommended design changes resulted in better room utilization, decreased congestion, and enhanced access to equipment.

Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes.

This paper describes the process and tools developed as part of a multidisciplinary collaborative simulation-based approach for iterative design and evaluation of operating room (OR) prototypes. Full-scale physical mock-ups of healthcare spaces offer an opportunity to actively communicate with and to engage multidisciplinary stakeholders in the design process. While mock-ups are increasingly being used in healthcare facility design projects, they are rarely evaluated in a manner to support active user feedback and engagement. Researchers and architecture students worked closely with clinicians and architects to develop OR design prototypes and engaged clinical end-users in simulated scenarios. An evaluation toolkit was developed to compare design prototypes. The mock-up evaluation helped the team make key decisions about room size, location of OR table, intra-room zoning, and doors location. Structured simulation based mock-up evaluations conducted in the design process can help stakeholders visualize their future workspace and provide active feedback.

Worksheets with embedded checklists support IV chemotherapy safer practice.

Following a review of a chemotherapy medication adverse event where the incorrect medication was prepared by a pharmacy, a number of steps were taken to review the literature and best practice information related to checking processes for the preparation of parenteral chemotherapy. Concepts such as identification of critical stop check points, independent double checks, and human factors principles were reviewed and incorporated into newly designed chemotherapy preparation worksheets with embedded checklists. Usability testing and staff feedback during implementation revealed a number of key learning points that resulted in additional work to further improve the chemotherapy worksheets with embedded checklists and highlighted the need for a culture of continuous quality improvement.

The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations).

Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting existing ones, to address the need for single-site flexible haemorrhage control. This manuscript therefore describes the many considerations in the design and refinement of the physical build, equipment selection, human factors evaluation of new combined treatment paradigms, and the final introduction of a RAPTOR protocol in order that others may learn from our initial efforts.

Avoiding Potential Medication Errors Associated with Non-intuitive Medication Abbreviations.

BACKGROUND: Pharmaceutical companies use a variety of abbreviations to denote short- and long-acting medications. Errors involving the administration of these medications are frequently reported. OBJECTIVES: To evaluate comprehension rates for abbreviations used to denote short- and long-acting medications and to evaluate whether changes to medication labels could reduce potential errors in the selection and administration of medications. METHODS: In phase 1 of the study, nursing staff were asked to define 4 abbreviations and then to categorize them by release rate. In phase 2, a simulation exercise, nursing staff were asked if it would be appropriate to administer a medication illustrated in a photograph (oxycodone CR 5-mg blister pack) on the basis of information highlighted in a screen shot of an electronic medication administration record (order for oxycodone 5 mg). Three different presentations were used to identify the medication in the medication administration record and on the drug label. RESULTS: In phase 1, 10 (28%) of 36 nursing staff members knew what all 4 abbreviations meant, and 14 (39%) correctly classified all 4 abbreviations as indicating a short- or a long-acting medication. In the simulation exercise (phase 2), labelling changes reduced the likelihood of a potential medication administration error. CONCLUSIONS: Most abbreviations used to indicate short- versus long-acting medications were not correctly understood by study participants. Of more concern was the incorrect interpretation of some abbreviations as indicating the opposite release rate (e.g., "ER" interpreted as meaning "emergency release", rather than "extended release", with incorrect classification as a short-acting medication). This evaluation highlighted the potential consequences of using non-intuitive abbreviations to differentiate high-risk medications having different release rates.

Standardizing anesthesia medication drawers using human factors and quality assurance methods.

PURPOSE: In Calgary, each of the three acute-care adult hospitals had different anesthetic medication carts with their own type and layout of anesthetic medications. A number of anesthesiologists moved among the different sites, increasing the potential for medication errors. The objective of this study was to identify the anesthetic medications to include and to determine how they should be grouped and positioned in a standardized anesthesia medication cart drawer. METHODS: A standardized list of medications was established. Next, the anesthesia medication cart drawer was filled and photographed, and a jigsaw puzzle was made from the photograph. Anesthesiologists and anesthesia assistants arranged the jigsaw pieces into an ideal drawer. Participants verbalized their rationale for the position of each puzzle piece. Results were collated and analyzed. A mock drawer was developed and reviewed by department members, and minor modifications were made. RESULTS: A final standardized medication drawer (content and positioning) was developed over 30 months, with agreement from anesthesiologists (n = 12) and anesthesia assistants (n = 3) at the three hospitals. Guidelines for placing each medication in the drawer included grouping them according to order of use, frequency of use, similarity of action, severity of harm from misuse, and lack of similar appearance. A finalized template was used for a standardized drawer and installed in every operating room of the three hospitals. CONCLUSION: Implementation of the standardized medication drawer is expected to reduce the likelihood of medication errors. Future research should include testing the clinical implications of this standardization and applying the methodology to other areas.

Refining the relationship between personality and subjective well-being.

Understanding subjective well-being (SWB) has historically been a core human endeavor and presently spans fields from management to mental health. Previous meta-analyses have indicated that personality traits are one of the best predictors. Still, these past results indicate only a moderate relationship, weaker than suggested by several lines of reasoning. This may be because of commensurability, where researchers have grouped together substantively disparate measures in their analyses. In this article, the authors review and address this problem directly, focusing on individual measures of personality (e.g., the Neuroticism-Extroversion-Openness Personality Inventory; P. T. Costa & R. R. McCrae, 1992) and categories of SWB (e.g., life satisfaction). In addition, the authors take a multivariate approach, assessing how much variance personality traits account for individually as well as together. Results indicate that different personality and SWB scales can be substantively different and that the relationship between the two is typically much larger (e.g., 4 times) than previous meta-analyses have indicated. Total SWB variance accounted for by personality can reach as high as 39% or 63% disattenuated. These results also speak to meta-analyses in general and the need to account for scale differences once a sufficient research base has been generated.

Is your patient ready for transport? Developing an ICU patient transport decision scorecard.

Transport of patients from the intensive care unit (ICU) to another area of the hospital can pose serious risks if the patient has not been assessed prior to transport. Recently, the Department of Critical Care Medicine, Calgary Health Region, experienced two adverse events during transport. A subgroup of the Department's Patient Safety and Adverse Events team developed an ICU patient transport decision scorecard. This tool was tested through Plan-Do-Study-Act cycles and further revised using human factors principles. Staff, especially novice nurses, found the tool extremely useful in determining patient preparedness for transport.