Applying Human Factors and Systems Simulation Methods to Inform a Multimillion-Dollar Healthcare Decision.

PURPOSE: This article describes a case study of a collaborative human factors (HF) and systems-focused simulation (SFS) project to evaluate potential patient and staff safety risks associated with a multimillion-dollar design and construction decision. BACKGROUND: The combined integration of HF and SFS methods in healthcare related to testing and informing the design of new environments and processes is underutilized. Few realize the effectiveness of this integration in healthcare to reduce risk and improve decision-making, safety, design, efficiency, patient experience, and outcomes. This project showcases how the combined use of HF and SFS methods can provide objective evidence to help inform decisions. METHODS: The project was initiated by a healthcare executive team looking for an objective, user informed analysis of a current connector passageway between two existing buildings. The goal was to understand the implications of keeping the current route for simultaneous use for public and patients service flow versus building and financing a new passageway for separate flow and transport. An interprofessional team of intensive care unit professionals participated in two simulations designed to test the current connector. A failure mode and effects analysis and qualitative debrief feedback was used to evaluate risks and potential failures. RESULTS: The evaluation resulted in data that enabled informed executive decision making for the most effective, efficient, and safest option for public, staff, and patient transport between two buildings. This evaluation resulted in the decision to go forward with building a multimillion-dollar new connector passageway to improve integrated care and transport.

System Configuration Evaluation for a Province-Wide Clinical Information System Using the eSafety Checklist.

BACKGROUND: According to Digital Health Canada 2013 eSafety Guidelines, an estimated one-third of patient safety incidents following implementation of clinical information systems (CISs) are technology-related. An eSafety checklist was previously developed to improve CIS safety by providing a comprehensive listing of system-agnostic, evidence-based configuration recommendations. OBJECTIVES: We sought to use the checklist to support safe initial configuration of a provincial system-wide CIS (Alberta, Canada), referred to as Connect Care. METHODS: The checklist was applied to 13 Connect Care modules in three successive phases. First, the checklist was adapted to an abbreviated high-priority version. Second, demonstrations of each module were recorded. Finally, independent evaluation of each recording was conducted by two eSafety evaluators using the abbreviated eSafety checklist. RESULTS: All modules achieved greater than 72% compliance, with an average of 84%. Overall, 273 opportunities for improvement were identified, with four major areas or themes emerging: (1) inconsistent date and time, (2) unclear patient identification, (3) ineffective alert system, and (4) insufficient decision support. These opportunities were forwarded to the appropriate build teams for review and implementation. CONCLUSION: This work is the first to utilize the eSafety checklist in a real-world CIS, which will become one of the largest in Canada. The checklist has shown clinical applicability in identifying gaps in CIS configuration and should be considered for use in future and pre-existing CISs.

LATCH (Lower Anchors and Tethers for CHildren) usability in school buses and passenger vehicles.

OBJECTIVE: The present study was designed to assess LATCH (Lower Anchors and Tethers for CHildren) usability in both cars and school buses. Despite being designed to make child restraint system (CRS) installation in vehicles easier and with fewer opportunities for misuse, there have been reports that LATCH is not as easy to use, or as effective, as hoped. To date, there have been few systematic or experimental studies evaluating LATCH usability. Further, based on research demonstrating that small children in school buses are not protected from injury in the same manner as larger children, motor vehicle safety regulations now require LATCH anchorages to be installed on a proportion of seats in all school buses, allowing for the installation of CRS. The main objectives of the study were to assess LATCH usability in cars and school buses and to make recommendations to improve its design and labeling. METHODS: Forty-eight paid participants (younger vs. older; experienced vs. not experienced) installed CRS in a car and a school bus using three different types of lower anchorage connectors and top tethers. Dependent measures included time to install and remove the CRS, frequency and seriousness of errors, and subjective usability reports. RESULTS: Surprisingly, many participants were not familiar with the LATCH system and believed that CRS should only be installed using the seat belt. Over 40% of participants did not know where the lower anchorage connectors were located in the car. While installation performance using LATCH was generally satisfactory (all CRS were installed correctly between 70 and 92% of the time), LATCH design improvements in terms of the CRS and both vehicles were identified. CONCLUSIONS: The study results generated a number of recommended design improvements that would improve LATCH usability in cars and school buses. These include: 1) clearly identifying LATCH anchors in both vehicle types by using clear, conspicuous labels or pictograms; 2) making LATCH anchors in all vehicles more accessible; 3) designing LATCH components for CRS that are easy to use correctly, provide adequate feedback to users, and are difficult to misuse; 4) anticipating, and designing to minimize, incompatibility between CRS and vehicles; 5) using maximum seat spacing in school buses for seats equipped with LATCH anchors; and, most importantly, 6) raising awareness of LATCH in the driving public.

Usability issues concerning child restraint system harness design.

A study was conducted to assess usability issues relating to child restraint system (CRS) harness design. Four convertible child restraint systems representing a wide variety of design features were used. Forty-two participants installed two child test dummies in both forward- and rear-facing configurations either inside or outside a test vehicle. Observer-scored checklists determined the degree to which each harness was installed correctly. Participant-scored questionnaires evaluated the 'ease-of-use' of various design features. While the percentage of correct installations exceeded 83% for all designs when installed in the forward-facing configuration, in the rear-facing position (that intended for children under 9-10 kg), there was a significant (between 65 and 89%) percentage of incorrect installations for all models. This finding is of particular interest and may be indicative of a more generalized problem with 'convertible' CRS designs when they are used in the rear-facing configuration. Furthermore, while certain design features were perceived by users as providing significantly better protection in the event of a collision, these also tended to be the features that were misused most often. The benefits and costs of various design features are discussed, and a method to test harness design usability is presented.