Conflicting benefits and hazards hospital style bed rails

This paper reviews the design and use of hospital-style bed rails. Rails were originally used as a safety feature for psychiatric patients at risk of falling in the 1800s. There are benefits, for example security in transit, facilitating repositioning, but also hazards, including deaths and injuries associated with entrapment. The developments in the technological specification of hospital beds (electric) has increased with their functionality. However, a survey in England and Wales found that patients on electric beds / pressure mattresses were three times more likely to have their rails raised. This may lead to an increase in the exposure to the risks associated with bed rails and presents a conflict for designers, staff and patients

Can inclusive environmental design be achieved in acute hospitals?

The effectiveness of healthcare delivery is determined, in part, by the design of the physical environment and the spatial organisation of work. This paper will consider firstly whether ergonomic input to provide recommendations for work space requirements may restrict patient autonomy and secondly, whether design developments for patient benefit may lead to difficulties in providing clinical care. The findings from two research studies are used to discuss the impact of physical layout on work systems with respect to staff well-being (space to work), patient care (monitoring) and patient experience (privacy and dignity). Several approaches to design and ward layout are considered, including Harness, Nucleus, AEDET, Planetree and Sengetun. Finally, the involvement of both staff and patients through a participatory ergonomics framework in building design is explored. It is suggested that mapping criteria for user participation in building design briefing with the participatory ergonomics framework may offer potential to improve and enhance patient involvement in hospital design

Musculoskeletal injury risks for ambulance workers

The provision of emergency and urgent care has been recognised for many years as exposing ambulance workers to high risks of musculoskeletal injuries (Turnbull et al, 1992; Rodgers, 1998; ROSPA, 2000; Lavender et al, 2000; Maguire et al, 2005). Although the tasks and job roles may vary in different countries (e.g. combination of paramedic and fire fighter roles), the evidence seems to be compelling that ‘ambulance workers [are] at a relatively higher risk of permanent medical impairment and early retirement on medical grounds than other occupational groups’ and have more ‘somatic health problems’ (e.g. musculoskeletal disorders) than the general population (Sterud et al, 2006). Recent research indicates that the prevalence of musculoskeletal discomfort and injuries may not have significantly reduced since the 1990s with over 50% of paramedics continuing to have musculoskeletal pain or discomfort on a regular basis (Arial et al, 2014); it seems reasonable to suggest that these problems may still be contributing to early retirement on medical grounds (Rodgers, 1998)

Smaller, lighter, faster? Reducing the carbon footprint of ambulances

This paper outlines a feasibility project investigating the potential for smaller, lighter rapid response vehicles (RRVs) in reducing the carbon footprint and response times of ambulances. Five stakeholder consultations were held with two ambulance trusts, an ambulance manufacturer, a paramedic and the Ultra-Light Vehicle Group to generate three novel design concepts for RRVs, which were then reviewed by four UK fleet managers and four clinicians. The results indicated that the integrated clinician service model could create a future market for smaller, lighter vehicles. Reducing carbon emissions in the short term will most likely be achieved using lower emission engines and improving engine and power management for dual-crewed ambulances. In the medium term (5–10 years), there will be a demand for low emission, composite light-weight dual-crewed ambulances

Silver bullets or buckshot? Patient falls and a systems model in healthcare facility design

Falls are associated with increased length of stay in hospitals and higher healthcare costs connected to additional care, discharges to institutional care and litigation claims. Under current US reimbursement programs, organizations are penalized for hospital-acquired conditions, including falls with injury not present on admission. This paper presents the results from a systematic mixed methods literature review on the correlates and interventions for patient falls. While the review is focused on conditions of the physical environment, these must be considered in the context of organizational and people-based factors to fully address the system complexity. A model for systems integration is proposed. Practitioner Summary: Healthcare organizations continue to struggle with preventing patient falls. Because of the multifactorial contributions to fall risk, falls reduction programs include multiple solutions with no ability to quantify the effectiveness of any particular component, and yet, the question is always asked, “What really worked?” Rather than seek silver bullets, we should establish frameworks that account for the interactions within the system that also a proactive approach to healthcare facility design

Using patient handling equipment to manage mobility in and around a bed.

Using patient handling equipment to manage mobility in and around a bed

Factors influencing the development of effective error management competencies in undergraduate UK pharmacy students

Patient safety (PS) is a key healthcare goal, yet health professionals struggle to acquire appropriate expertise, including Human Factors/Ergonomics skills, reflected in undergraduate curricula content. More than 50% of adverse events are medicines-related, yet focus on pharmacists as experts in medicines is scant. This pilot investigation used focus groups and interviews to explore undergraduate PS teaching in purposively-selected UK pharmacy schools. Results revealed barriers to PS teaching including risk-averse pharmacist ‘personality’ and Educational Standards negatively influencing students’ error-management behaviours

A tool to measure the success of patient handling interventions across the European Union

Patient handling intervention strategies are many and varied. The focus of interventions has primarily been on the health, safety and welfare of care givers. Data from 4 EU focus groups and 2 world-wide expert panels were used to evaluate whether other types of outcomes were perceived as having relative importance. Qualitative and quantitative analysis showed that organisational and patient outcomes were also highly rated by the participants. The data had good agreement between the 4 different EU sources (Kendall’s Concordance significant at 0.005) and the 12 highest rated measures were considered eligible for inclusion in further study. In parallel, a wide ranging analysis of patient handling intervention literature was considered to evaluate the qualities of each individual study. Using the 12 most important outcomes from the initial study and the most appropriate and accessible measurement tools from the literature analysis, the Intervention Evaluation Tool (IET) is proposed. The IET is a single set of measurements that can be used for evaluating all organisational and individual patient handling interventions in healthcare

Can the NHS learn about human factors from the Ministry of Defence?

The National Health Service (NHS) in England has ambitious plans to drive innovation in health information technology (HIT) to improve patient safety, quality and cost effectiveness. Acute trusts are complex socio-technical systems that are required to implement a number of large information technology projects in order to meet national targets for digital maturity. This research explored whether the Ministry of Defence (MOD) Human Factors Integration Model for the acquisition process could be applied to a HIT project. A qualitative research study was undertaken in a large English NHS acute trust using the experience of implementing an electronic observation system to explore transferability of the MOD approach to acute healthcare. Data were collected using semi-structured interviews and focus groups and analysed thematically with reference to SEIPS 2.0 (Holden et al, 2013) healthcare systems model and the MOD framework. Key findings included limited awareness of Human Factors in healthcare; information system design/specification to deliver positive outcomes around patient safety and financial savings. Human Factors negative systems issues included alert fatigue, changing mental models, inability to maximise data for patient benefit, system resilience, local and national interoperability issues

Ergonomics /human factors education in United Kingdom

This paper presents a summary of the Ergonomics and Human Factors (EHF) professional accreditation process in the UK. EHF education can be accredited by the Chartered Institute of Ergonomics and Human Factors (CIEHF) as qualifying courses and as short (training) courses. A framework is used as professional competencies (5 units) with expected levels of proficiency to support career development through membership grades (student, graduate, registered, fellow). An example of education is given with the 5 postgraduate programmes (MSc, Postgraduate Diploma, Postgraduate Certificate) at Loughborough University: Ergonomics and Human Factors, Human Factors in Transport. Human Factors for Inclusive Design, Ergonomics in Health and Community Care, and Human Factors and Ergonomics for Patient Safety. Finally, an opportunity is offered to explore competency with an affiliate discipline (Unser Experience) in the context of usability testing for medical devices