Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: A systematic review.

INTRODUCTION: Poorly designed electronic medication management systems (EMMS) or computerized physician order entry (CPOE) systems in hospital settings can result in usability issues and in turn, patient safety risks. As a safety science, human factors and safety analysis methods have potential to support the safe and usable design of EMMS. OBJECTIVE: To identify and describe human factors and safety analysis methods that have been used in the design or redesign of EMMS used in hospital settings. MATERIALS AND METHODS: A systematic review, following PRISMA guidelines, was conducted by searching online databases and relevant journals from January 2011 to May 2022. Studies were included if they described the practical application of human factors and safety analysis methods to support the design or redesign of a clinician-facing EMMS, or its components. Methods used were extracted and mapped to human centered design (HCD) activities: understanding context of use; specifying user requirements; producing design solutions; and evaluating the design. RESULTS: Twenty-one papers met the inclusion criteria. Overall, 21 human factors and safety analysis methods were used in the design or redesign of EMMS with prototyping, usability testing, participant surveys/questionnaires and interviews the most frequent. Human factors and safety analysis methods were most frequently used to evaluate the design of a system (n = 67; 56.3%). Nineteen of 21 (90%) methods used aimed to identify usability issues and/or support iterative design; only one paper utilized a safety-oriented method and one, a mental workload assessment method. DISCUSSION AND CONCLUSION: While the review identified 21 methods, EMMS design primarily utilized a subset of available methods, and rarely a method focused on safety. Given the high-risk nature of medication management in complex hospital environments, and the potential for harm due to poorly designed EMMS, there is significant potential to apply more safety-oriented human factors and safety analysis methods to support EMMS design.

"Experience Isn't Everything": How Emotion Affects the Relationship Between Experience and Cue Utilization.

OBJECTIVE: This research examined whether negative and positive arousal emotions modify the relationship between experience level and cue utilization among anesthetists. BACKGROUND: The capacity of a practitioner to form precise associations between clusters of features (e.g., symptoms) and events (e.g., diagnosis) and then act on them is known as cue utilization. A common assumption is that practice experience allows opportunities for cue acquisition and cue utilization. However, this relationship is often not borne out in research findings. This study investigates the role of emotional state in this relationship. METHOD: An online tool (EXPERTise 2.0) was used to assess practitioner cue utilization for tasks relevant to anesthesia. The experience of positive and negative arousal emotions in the previous three days was measured, and emotion clusters were generated. Experience was measured as the composite of practice years and hours of practice experience. The moderating role of emotion on the relationship between experience and cue utilization was examined. RESULTS: Data on 125 anesthetists (36% female) were included in the analysis. The predicted interaction between arousal emotions and the experience level emerged. In particular, post hoc analyses revealed that anxiety-related emotions facilitated the likelihood of high cue utilization in less experienced practitioners. CONCLUSION: The findings suggest a role for emotions in cue use and suggest a functional role for normal range anxiety emotions in a simulated work-relevant task. APPLICATION: This research illustrates the importance of understanding the potentially functional effects common negative arousal emotions may have on clinical performance, particularly for those with less experience.

Positive Affect Is Associated With Reduced Fixation in a Realistic Medical Simulation.

OBJECTIVE: This study extends previous research by exploring the association between mood states (i.e., positive and negative affect) and fixation in practicing anesthetists using a realistic medical simulation. BACKGROUND: The impact of practitioner emotional states on fixation is a neglected area of research. Emerging evidence is demonstrating the role of positive affect in facilitating problem solving and innovation, with demonstrated implications for practitioner fixation. METHOD: Twelve practicing anesthetists (4 females; Mage= 39 years; SD = 6.71) were involved in a medical simulation. Prior to the simulation, practitioners rated the frequency they had experienced various positive and negative emotions in the previous three days. During the simulation, the patient deteriorated rapidly, and anesthetists were observed for their degree of fixation. After the simulation, practitioners indicated the frequency of these same emotions during the simulation. RESULTS: Nonparametric correlations were used to explore the independent relationships between positive and negative affect and the behavioral measures. Only positive affect impacted the likelihood of fixation. Anesthetists who reported more frequent recent positive affect in the three days prior to the simulation and during the simulation tended to be less fixated as judged by independent raters, identified a decline in patient oxygen saturation more quickly, and more rapidly implemented the necessary intervention (surgical cricothyroidotomy). CONCLUSION: These findings have some real-world implications for positive affect in patient safety. APPLICATION: This research has broad implications for professions where fixation may impair practice. This research suggests that professional training should teach practitioners to identify their emotions and understand the role of these emotions in fixation.

Expert and competent non-expert visual cues during simulated diagnosis in intensive care.

The aim of this study was to examine the information acquisition strategies of expert and competent non-expert intensive care physicians during two simulated diagnostic scenarios involving respiratory distress in an infant. Specifically, the information acquisition performance of six experts and 12 competent non-experts was examined using an eye-tracker during the initial 90 s of the assessment of the patient. The results indicated that, in comparison to competent non-experts, experts recorded longer mean fixations, irrespective of the scenario. When the dwell times were examined against specific areas of interest, the results revealed that competent non-experts recorded greater overall dwell times on the nurse, where experts recorded relatively greater dwell times on the head and face of the manikin. In the context of the scenarios, experts recorded differential dwell times, spending relatively more time on the head and face during the seizure scenario than during the coughing scenario. The differences evident between experts and competent non-experts were interpreted as evidence of the relative availability of task-specific cues or heuristics in memory that might direct the process of information acquisition amongst expert physicians. The implications are discussed for the training and assessment of diagnostic skills.

Trait-based cue Utilization and initial skill acquisition: implications for models of the progression to expertise.

The primary aim of this study was to examine the role of cue utilization in the initial acquisition of psycho-motor skills. Two experiments were undertaken, the first of which examined the relationship between cue utilization typologies and levels of accuracy following four simulated, power-off landing trials in a light aircraft simulator. The results indicated that higher levels of cue utilization were associated with a greater level of landing accuracy following training exposure. In the second study, participants' levels of cue utilization were assessed prior to two 15 min periods during which they practiced take-offs and landings using a simulated unmanned aerial vehicle (UAV). Consistent with Study 1, the outcomes of Study 2 revealed a statistically significant relationship among levels of cue utilization and the number of trials to criterion on the take-off task, and the proportion of successful trials during both take-off and landing. In combination, the results suggest that the capacity for the acquisition and the subsequent utilization of cues is an important predictor of skill acquisition, particularly during the initial stages of the process. The implications for theory and applied practice are discussed.

An objective approach to identifying diagnostic expertise among power system controllers.

OBJECTIVE: The present study investigated whether performance across a range of cue-based cognitive tasks differentiated the diagnostic performance of power control operators into three distinct groups, characteristic of novice, competence, and expertise. BACKGROUND: Despite its increasing importance in the contemporary workplace, there is little understanding of the cognitive processes that distinguish novice, competent, and expert performance in the context of remote diagnosis. However, recent evidence suggests that cue acquisition and utilization may represent a mechanism by which the transition from novice to expertise occurs. METHOD: The study involved the application of four distinct cue-based tasks within the context of power system control. A total of 65 controllers, encompassing a range of industry experience, completed the tasks as part of an in-service training program. RESULTS: Using a cluster analysis, it was possible to extract three distinct groups of operators on the basis of their performance in the cue-based tasks, and these groups corresponded to differences in diagnostic performance. CONCLUSION: The results indicate assessments of the capacity to extract and utilize cues were able to distinguish expert from competent practitioners in the context of power control. APPLICATION: Assessments of the capacity to extract and utilize cues may be used in the future to distinguish expert from nonexpert practitioners, particularly in the context of remote diagnosis.

The capability of static and dynamic features to distinguish competent from genuinely expert practitioners in pediatric diagnosis.

OBJECTIVE: The authors describe the development of a new, more objective method of distinguishing experienced competent nonexpert from expert practitioners within pediatric intensive care. BACKGROUND: Expert performance involves the acquisition and use of refined feature-event associations (cues) in the operational environment. Competent non-experts, although experienced, possess rudimentary cue associations in memory. Thus, they cannot respond as efficiently or as reliably as their expert counterparts, particularly when key diagnostic information is unavailable, such as that provided by dynamic cues. METHOD: This study involved the application of four distinct tasks in which the use of relevant cues could be expected to increase both the accuracy and the efficiency of diagnostic performance. These tasks included both static and dynamic stimuli that were varied systematically. A total of 50 experienced pediatric intensive staff took part in the study. RESULTS: The sample clustered into two levels across the tasks: Participants who performed at a consistently high level throughout the four tasks were labeled experts, and participants who performed at a lower level throughout the tasks were labeled competent nonexperts. The groups differed in their responses to the diagnostic scenarios presented in two of the tasks and their ability to maintain performance in the absence of dynamic features. CONCLUSION: Experienced pediatricians can be decomposed into two groups on the basis of their capacity to acquire and use cues; these groups differ in their diagnostic accuracy and in their ability to maintain performance in the absence of dynamic features. APPLICATION: The tasks may be used to identify practitioners who are failing to acquire expertise at a rate consistent with their experience, position, or training. This information may be used to guide targeted training efforts.