RESUMO
INTRODUCTION: A hierarchical structure is where all individuals are organized according to importance and are subordinate to a single person. In the operating room (OR), this structure may negatively impact the quality of communication and jeopardize patient safety. We examined how the surgical team's hierarchical relationships affect the frequency and timing of risk communication, and their influence on situational awareness (SA) in the OR. METHODS: Overhead cameras and lapel microphones were used to record the OR environment. Recordings and transcriptions of 10 robot-assisted prostatectomies were examined for risk utterances among team members. Utterances were classified by sender-recipient exchange, timing (determined by phrasing to be proactive or reactive to an error/negative event), and the Oxford Non-Technical Skills (NOTECHS) SA score. Surgeon's and trainee surgeon's utterances were classified by their on-console status. Chi-square tests were used to determine associations between dependent factors, and ANOVAs were used to evaluate the effect of hierarchy and timing on NOTECHS score. RESULTS: Of 4,583 examined utterances, 329 (7%) were risk-related. There was no significant difference in utterance frequency based on hierarchical status of sender and recipient (p = 0.16). Utterances made by the surgeon or trainee surgeon had higher NOTECHS scores when off versus on the console (scores: 1.8 vs 2.4, p < 0.01). These utterances were more reactive on the console (32%) and proactive off the console (28%). Proactive utterances had higher NOTECHS scores than reactive utterances (scores: 2.5 vs 1.8, p < 0.01). CONCLUSION: The surgical hierarchy significantly impacted the frequency of risk communication within the OR. Timing and on-console status further influenced the efficacy of risk communication.
Assuntos
Procedimentos Cirúrgicos Robóticos , Cirurgiões , Comunicação , Humanos , Salas Cirúrgicas , Equipe de Assistência ao PacienteRESUMO
BACKGROUND: The current state of scientific knowledge regarding communication between emergency medicine (EM) providers indicates that communication is critical to safe and effective patient care. OBJECTIVES: In this study, we identified communication needs of EM nurses and physicians; in particular, what information should be conveyed, when, how, and to whom. METHODS: Five semi-structured focus groups and one interview were conducted with nine nurses, eight attending physicians, and four residents. Questions addressed how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share. Sessions were audio recorded. Transcripts were generated and analyzed using a concept mapping approach (a visual qualitative analysis technique to represent and convey synthesized knowledge). RESULTS: Eleven concept maps were produced summarizing: information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication. CONCLUSIONS: Our main finding of this research is that communication ensures shared awareness of patient health status, the care plan, status of plan steps and orders, and, especially, any critical changes or "surprises" regarding the health of a patient. Additionally, the research identified shared information needs; communication methods, strategies and barriers; and factors affecting successful communication, and has implications for both system and training design. Key implications for emergency nursing practice from this research are distilled in 10 'best practice' strategies for improving EM nurse-physician communication.
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Comunicação , Medicina de Emergência , Grupos Focais , Humanos , Corpo Clínico Hospitalar , Pesquisa QualitativaRESUMO
This investigation examined the impact of speech-generating devices (SGDs) on the interaction dynamics (i.e., symmetry) of augmented speakers and their conversation partners while performing several interaction tasks. This study involved 20 dyads: 10 in which one individual had ALS and primarily used an SGD for communication while the other participant primarily used speech (AS group); and 10 in a control group comprised of individuals who used speech as a primary means of communication (OS group). Interactions between participants in the AS group were compared across four tasks (i.e., map, retell, sequencing, and personal narrative). These results were also compared to performances of participants in the OS group performing the same tasks. Task completion times, talk times, contribution types (i.e., main/repair), and contribution functions (i.e., presentation/acceptance) were used to index symmetry performance patterns across tasks for the 20 dyads. Within- and between-group comparisons were significant in differentiating the two groups in terms of the ways in which they were able to adapt to different interaction task dynamics. Findings suggest symmetry is a useful metric for identifying the constraining influence of carrying out in-person interactions with an SGD.
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Esclerose Lateral Amiotrófica/reabilitação , Auxiliares de Comunicação para Pessoas com Deficiência , Transtornos da Comunicação/reabilitação , Relações Interpessoais , Fala , Adulto , Idoso , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit. METHODS: We performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018. RESULTS: The most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%). CONCLUSIONS: Emergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.
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Barreiras de Comunicação , Serviço Hospitalar de Emergência/organização & administração , Relações Profissional-Paciente , Tradução , Adulto , Pessoal Técnico de Saúde/organização & administração , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Telefone , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
Cognitive engineering is an applied field with roots in both cognitive science and engineering that has been used to support design of information displays, decision support, human-automation interaction, and training in numerous high risk domains ranging from nuclear power plant control to transportation and defense systems. Cognitive engineering provides a set of structured, analytic methods for data collection and analysis that intersect with and complement methods of Cognitive Informatics. These methods support discovery of aspects of the work that make performance challenging, as well as the knowledge, skills, and strategies that experts use to meet those challenges. Importantly, cognitive engineering methods provide novel representations that highlight the inherent complexities of the work domain and traceable links between the results of cognitive analyses and actionable design requirements. This article provides an overview of relevant cognitive engineering methods, and illustrates how they have been applied to the design of health information technology (HIT) systems. Additionally, although cognitive engineering methods have been applied in the design of user-centered informatics systems, methods drawn from informatics are not typically incorporated into a cognitive engineering analysis. This article presents a discussion regarding ways in which data-rich methods can inform cognitive engineering.
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Cognição , Apresentação de Dados , Informática Médica , Interface Usuário-Computador , Coleta de Dados , HumanosRESUMO
OBJECTIVE: To analyse ambulatory movements and team dynamics during robot-assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events. METHODS: With institutional review board approval, we retrospectively reviewed 10 recorded robot-assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose. Movements were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure). RESULTS: The mean operating time was 166 min, of which ambulation constituted 27 min (16%). A total of 2 896 ambulatory movements were identified (mean: 290 ambulatory movements/procedure). Most of the movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR; the heaviest traffic was between the circulating nurse zone, transit zone and supply-1 zone. A total of 50% of ambulatory movements were found to be avoidable. CONCLUSION: More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety.
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Processos Grupais , Salas Cirúrgicas , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos , Fluxo de Trabalho , Humanos , Erros Médicos , Movimento , Equipe de Assistência ao Paciente , Estudos RetrospectivosRESUMO
BACKGROUND: Communication problems have been systematically linked to human errors in surgery and a deep understanding of the underlying processes is essential. Although a number of tools exist to assess nontechnical skills, methods to study communication and other team-related processes are far from being standardized, making comparisons challenging. We conducted a systematic review to analyze methods used to study events in the operating room (OR) and to develop a synthesized coding scheme for OR team communication. MATERIALS AND METHODS: Six electronic databases were accessed to search for articles that collected individual events during surgery and included detailed coding schemes. Additional articles were added based on cross-referencing. That collection was then classified based on type of events collected, environment type (real or simulated), number of procedures, type of surgical task, team characteristics, method of data collection, and coding scheme characteristics. All dimensions within each coding scheme were grouped based on emergent content similarity. Categories drawn from articles, which focused on communication events, were further analyzed and synthesized into one common coding scheme. RESULTS: A total of 34 of 949 articles met the inclusion criteria. The methodological characteristics and coding dimensions of the articles were summarized. A priori coding was used in nine studies. The synthesized coding scheme for OR communication included six dimensions as follows: information flow, period, statement type, topic, communication breakdown, and effects of communication breakdown. CONCLUSIONS: The coding scheme provides a standardized coding method for OR communication, which can be used to develop a priori codes for future studies especially in comparative effectiveness research.
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Comunicação , Salas Cirúrgicas , Equipe de Assistência ao Paciente , HumanosRESUMO
Models used for the design and service delivery of Augmentative and Alternative Communication (AAC) systems are limited. There are no standardized protocols for gathering user requirements beyond clinical/diagnostic information relating to AAC access needs (i.e., physical and cognitive capabilities). Nonetheless, information on the social, cultural, and psychological aspects of technology orientation and use are important to understanding how an AAC system will complement the user's lifestyle, personal goals, values, and activities. Persona development is a user-centered design method that creates descriptive user models of different segments of a user population. Personas describe users' personal characteristics, and the ways in which they think, behave, and engage in activities (with or without technology). The objective of this study is to investigate the utility of user personas as a supplementary tool to aid SLPs in AAC assessment and service delivery.Three personas of individuals with Amyotrophic Lateral Sclerosis (ALS) were developed and validated in our prior research. Twelve SLPs engaged in mock AAC assessments of the three ALS case studies under two conditions: with or without the use of personas as a supplemental informational tool. By and large, there were no statistically significant differences between groups across objective measures; however, interview sessions with the SLP participants revealed benefits to using personas during clinical decision-making, particularly for training novice SLPs. Discussion also focuses on ways in which user personas can be adapted and improved to mitigate some of the challenges and risks identified.
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Esclerose Lateral Amiotrófica , Auxiliares de Comunicação para Pessoas com Deficiência , Humanos , Esclerose Lateral Amiotrófica/terapia , Tomada de DecisõesRESUMO
OBJECTIVE: To study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters. METHODS: English proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper. Key themes and differences across interpreter types were established through qualitative analysis. Themes and differences across interpreter type were vetted and updated through member checking interviews. RESULTS: 6 English proficient and 9 limited English proficient patients were observed. Key themes in communicative tasks included: establishing, maintaining, updating, and repairing understanding and rapport. All tasks were observed with English proficient and limited English proficient patients. The difference with limited English proficient patients was that medical interpreters played an active role in completing communicative tasks. Telephone-based interpreters faced challenges in facilitating communicative tasks based on thematic comparisons with in-person interpreters, including issues hearing and lost information due to the lack of visual cues. CONCLUSIONS: Professional interpreters play an important role in communication between language discordant patients and health professionals that goes beyond verbatim translation. PRACTICAL IMPLICATIONS: Training for interpreters and health professionals, and the design of tools for facilitating language discordant communication, should consider the role of interpreters beyond verbatim translation.
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Medicina de Emergência , Proficiência Limitada em Inglês , Barreiras de Comunicação , Humanos , Idioma , TraduçãoRESUMO
INTRODUCTION: During robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members' ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these constraints. OBJECTIVES: Explore the use of microanalysis to describe and evaluate communicative efficiency in RAS through examination of referencing in surgical tasks. METHODS: All communications during ten robot-assisted pelvic surgeries (radical cystectomies and prostatectomies) were fully transcribed. Forty-six referencing events were identified within these and subjected to a process of microanalysis. Microanalysis employs detailed transcription of speech and gesture along with their relative timing/sequencing to describe and analyse interactions. A descriptive taxonomy for referencing strategies was developed with categories including references reliant exclusively on speech (anatomic terms/directional language and context dependent words (CD)); references reliant exclusively on gesture or available aspects of the environment (point/show, camera focus/movement in the visual field and functional movement); and references reliant on the integrated use of speech and gesture/environmental support (integrated communication (IC)). Frequency of utilisation and number/percent 'miscommunication', were collated within each category when miscommunication was defined as any reference met with incorrect or no identification of the target. RESULTS: IC and CD were the most frequently used strategies (45% and 26%, respectively, p≤0.01). Miscommunication was encountered in 22% of references. The use of IC resulted in the fewest miscommunications, while CD was associated with the most miscommunications (42%). Microanalysis provided insight into the causes and nature of successful referencing and miscommunication. CONCLUSIONS: In RAS, surgeons complete referencing tasks in a variety of ways. IC may provide an effective means of referencing, while other strategies may not be adequately supported by the environment.
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Procedimentos Cirúrgicos Robóticos , Atenção , Gestos , Humanos , Projetos Piloto , FalaRESUMO
INTRODUCTION: Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study is to use electronic health record (EHR) data to predict the amount of work that individual patients contribute to clinician workload (patient-related workload). METHODS: One month of EHR data was retrieved from an emergency department (ED). A list of workload indicators and five potential workload proxies were extracted from the data. Linear regression and four machine learning classification algorithms were utilized to model the relationship between the indicators and the proxies. RESULTS: Linear regression proved that the indicators explained a substantial amount of variance of the proxies (four out of five proxies were modeled with R2 > 0.80). Classification algorithms also showed success in classifying a patient as having high or low task demand based on data from early in the ED visit (e.g. 80 % accurate binary classification with data from the first hour). CONCLUSION: The main contribution of this study is demonstrating the potential of using EHR data to predict patient-related workload automatically in the ED. The predicted workload can potentially help in managing clinician workload by supporting decisions around the assignment of new patients to providers. Future work should focus on identifying the relationship between workload proxies and actual workload, as well as improving prediction performance of regression and multi-class classification.
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Médicos , Carga de Trabalho , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência , HumanosRESUMO
'Safety-II' is a new approach to safety, which emphasizes learning proactively about how safety and efficacy are achieved in everyday frontline work. Previous research developed a new lesson-sharing tool designed based on the Safety-II approach: Resilience Engineering Tool to Improve Patient Safety (RETIPS). The tool comprises questions designed to elicit narratives of adaptations that have contributed to effectiveness in care delivery. The purpose of this study is to revise and validate the design of RETIPS. The tool was revised based on feedback of clinicians at a large multi-specialty hospital, resulting in a version customized for anesthesia residents, RETIPS-AnRes. RETIPS-AnRes was administered on a pilot-basis to anesthesia resident groups for a limited period of time. A review of the reports obtained shows a strong alignment of responses with the conceptual basis of the tool, i.e. learning about how things go well in everyday work. The exemplars include both, specific instances of successful patient care, as well as generic routines that contribute to safe and/or effective care delivery. These findings support RETIPS as a tool to operationalize the Safety-II paradigm in healthcare. Lessons and implications for implementation on a wider scale are discussed.
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Sistema de Aprendizagem em Saúde/organização & administração , Cultura Organizacional , Segurança do Paciente , Gestão de Riscos/organização & administração , Gestão da Segurança/organização & administração , Adulto , Anestesiologia/organização & administração , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Assistência ao Paciente , Projetos Piloto , Pesquisa QualitativaRESUMO
Augmentative and Alternative Communication (AAC) devices include special purpose electronic devices that generate speech output and are used by individuals to augment or replace vocal communication. Word prediction, including context specific prediction, has been proposed to help overcome barriers to the use of these devices (e.g., slow communication rates and limited access to situation-related vocabulary), but has not been tested in terms of effects during actual task performance. In this study, we compared AAC device use, task performance, and user perceptions across three tasks, in conditions where the AAC device used either was, or was not, primed with task specific vocabularies. The participants in this study were adults with normal physical, cognitive, and communication abilities. Context priming had a marginally significant effect on AAC device use as measured by keystroke savings; however, these advantages did not translate into higher level measures of rate, task performance, or user perceptions. In contrast, there were various statistically significant process and performance differences across task type. Additionally, results for two different emulations of human performance showed significant keystroke savings across context conditions. However, these effects were mitigated in actual performance and did not translate into keystroke savings. This indicates to AAC device designers and users that keystroke-based measures of device use may not be predictive of high level performance.
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Auxiliares de Comunicação para Pessoas com Deficiência , Comunicação , Vocabulário , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Software , Adulto JovemRESUMO
This article reviews studies conducted "in the wild" that explore the "ironies of automation" in Robotic Assisted Surgery (RAS). Workload may be reduced for the surgeon, but increased for other team members, with postural stress relocated rather than reduced, and the introduction of a range of new challenges, for example, in the need to control multiple arms, with multiple instruments; and the increased demands of being physically separated from the team. Workflow disruptions were not compared with other surgeries; however, the prevalence of equipment and training disruptions differs from other types of surgeries. A consistent observation is that communication and coordination problems are relatively frequent, suggesting that the surgical team may need to be trained to use specific verbal and non-verbal cues during surgery. RAS also changes the necessary size of the operating room instrument cleaning processes. These studies demonstrate the value of clinically-based human factors engineers working alongside surgical teams to improve the delivery of RAS.
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Comunicação , Procedimentos Cirúrgicos Robóticos , Fluxo de Trabalho , Ergonomia , Processos Grupais , Humanos , Equipe de Assistência ao Paciente , Postura , Carga de TrabalhoRESUMO
Communication breakdowns in the operating room (OR) have been linked to errors during surgery. Robot-assisted surgery (RAS), a new surgical technology, can lead to new challenges in communication owing to the remote location of the surgeon away from the patient and bedside assistants. Nevertheless, few studies have studied communication strategies during RAS. In this study, 11 robot-assisted radical prostatectomies were recorded and the interaction events between the surgeon and two bedside surgical team members were categorized by modality (verbal/nonverbal), topic, and pair (sender and receiver). Both verbal and nonverbal modalities were used by all pairs. The percentage of nonverbal interactions differed significantly by pair: 66% for the Surgeon-Physician Assistant, 50% for the Physician Assistant-Scrub Nurse, and 25% for the Surgeon-Scrub Nurse, indicating different communication strategies across pairs. In addition, there was a significant dependence between topic and the percentages of verbal and nonverbal events for all pairs. Strategies to improve team communication during RAS should take into account the use of verbal and nonverbal communication means and the variation in interaction strategies based on the topic of communication.
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Gestos , Equipe de Assistência ao Paciente , Procedimentos Cirúrgicos Robóticos , Humanos , Enfermeiras e Enfermeiros , Salas Cirúrgicas , Assistentes Médicos , Papel Profissional , Prostatectomia/métodos , Fala , CirurgiõesRESUMO
BACKGROUND: Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. OBJECTIVE: This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. METHODS: ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed. RESULTS: Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire-mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives. CONCLUSION: A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.
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Registros Eletrônicos de Saúde , Medicina de Emergência/métodos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Controle de Qualidade , Fatores de Tempo , Interface Usuário-ComputadorRESUMO
Many studies on teams report measures of team communication; however, these studies vary widely in terms of the team characteristics, situations, and tasks studied making it difficult to understand impacts on team communication more generally. The objective of this review is systematically summarize relationships between measures of team communication and team characteristics and situational contexts. A literature review was conducted searching in four electronic databases (PsycINFO, MEDLINE, Ergonomics Abstracts, and SocINDEX). Additional studies were identified by cross-referencing. Articles included for final review had reported at least one team communication measure associated with some team and/or context dimension. Ninety-nine of 727 articles met the inclusion criteria. Data extracted from articles included characteristics of the studies and teams and the nature of each of the reported team and/or context dimensions-team communication properties relationships. Some dimensions (job role, situational stressors, training strategies, cognitive artifacts, and communication media) were found to be consistently linked to changes in team communication. A synthesized diagram that describes the possible associations between eleven team and context dimensions and nine team communication measures is provided along with research needs.
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Comunicação , Processos Grupais , Adulto , Feminino , Humanos , Relações Interpessoais , MasculinoRESUMO
STUDY OBJECTIVE: We characterize and describe the communication links and patterns between and within emergency department (ED) practitioner types. METHODS: This is a prospective, observational study of emergency physician and nursing staff communication patterns in an academic ED using link analysis techniques. Twenty ED staff members were observed in the pediatric and adult acute areas of the ED, including attending physicians, residents, nurses, and charge nurses. Data were recorded for each communication event, including duration, mode, partner, location, and interruptions. Because this study was intended to focus on professionally related communication between staff, social interactions and direct patient interactions were excluded. Frequency percentage and duration were calculated for each measure, and link analysis graphs were prepared to assist in interpretation of the data. RESULTS: One thousand six hundred sixty-five total communication events were recorded during a total of 39 hours 12 minutes of observation. Face-to-face communication was the most common mode. Communication links and patterns were described and graphically represented using a link analysis technique. Communication gaps were found between ambulance providers and the providers who would ultimately take care of the patient during their ED stay. Attending physicians communicated often despite caring for separate patients, and the charge nurse seemed to be the hub for communication, linking ED personnel with non-ED staff. In the adult area, interruption rates ranged from 6.9 per hour (attending physician) to 0.5 per hour (bedside nurse), and in the pediatric area they ranged from 3.6 per hour (attending physician) to 0.3 (bedside nurse). CONCLUSION: Distinct patterns are identified. These results will be helpful in designing future communication adjuncts in the ED.
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Comunicação , Serviço Hospitalar de Emergência/organização & administração , Relações Interprofissionais , Recursos Audiovisuais , Comportamento Cooperativo , Humanos , Internato e Residência/organização & administração , Corpo Clínico Hospitalar/organização & administração , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Observação , Estudos Prospectivos , Análise e Desempenho de Tarefas , Recursos HumanosRESUMO
This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the display's ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components. Mean ratings were positive for cognitive performance support objectives, usability, usefulness, and frequency of use, demonstrating the successful application of design methods to create useful and usable EDIS concepts that provide cognitive support for emergency medicine staff. Nurse and provider roles had significantly different perceptions of the usability and usefulness of certain EDIS components, suggesting that they have different information needs while working.
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Serviço Hospitalar de Emergência , Sistemas de Informação , Design de Software , Interface Usuário-Computador , Cognição , Serviço Hospitalar de Emergência/organização & administração , Ergonomia , Humanos , Sistemas de Identificação de Pacientes , Análise e Desempenho de Tarefas , Fluxo de Trabalho , Carga de TrabalhoRESUMO
We describe the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. Emergency medicine physicians and nurses were observed for 2 h periods. Researchers used paper notes to document the characteristics (e.g., partners involved, location of communication, who initiated communication) and content of nurse to physician conversations. Eighteen emergency nurses and physicians (nine each) were observed for a total of 36 h. Two hundred and fifty-five unique communication events were recorded across three emergency departments spread evenly across day, evening, and night shifts. A qualitative analysis of communication event content revealed 5 types of communication and 13 content themes. Content themes covered a broad range of topics including exchange of patient health information, management of the ED, and coordination of orders. Physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas. This study describes nature of verbal nurse to physician communication in the ED. Direct communication is still used to communicate important information, such as information about patients' status, in EDs with established electronic health records. Our results provide an overview of information exchanged in the ED which can serve as a basis for designing improved information support systems.