“Breaking” the Emergency Department: Does the Culture of Emergency Medicine Present a Barrier to Self-Care?

Introduction: Our goal was to critically examine emergency physician’s (EP) beliefs about taking breaks for self-care on shift. Our operational definition of a break for self-care included time not engaging in direct patient care, eating, drinking, using the bathroom, or leaving a clinical area for a mental break. Using focus groups, the study aimed to accomplish the following: 1) identify barriers to why residents and faculty at our academic center may not take breaks in the emergency department; 2) generate hypotheses for empirical testing; and 3) generate solutions to include in a departmental breaks initiative.Methods: We convened eight focus groups comprised separately of resident and faculty physicians. Group discussion was guided by eight questions representing a priori themes. The groups were recorded for transcription and subjected to a “cut-and-sort” process. Six themes were identified by consensus after independent review by three of the co-authors, which were confirmed by participant validation.Results: We identified six themes that represented the pooled outcomes of both resident and faculty focus groups: 1) Physiological needs affect clinical performance, 2) EPs share beliefs around taking breaks that center on productivity, patient safety and the dichotomy of strength/weakness, 3) when taking breaks EPs fear worst-case scenarios, 4) breaking is a learned skill, 5) culture change is needed to allow EPs to engage in self-care; and 6) a flexible, individualized approach to breaking is necessary. Our central finding was that productivity and patient safety are of key importance to EPs when considering whether to take a break for self-care. We identified a dichotomy with the concept of strength related to productivity/patient safety, and the concept of weakness related to self-care.Conclusion: The current practice culture of emergency medicine and the organization of our unique work environment may present barriers to physicians attempting to engage in self-care

Exploring the importance of reflection in the control room

While currently difficult to measure or explicitly design for, evidence suggests that providing people with opportunities to reflect on experience must be recognized and valued during safety-critical work. We provide an insight into reflection as a mechanism that can help to maintain both individual and team goals. In the control room, reflection can be task-based, critical for the 'smooth' day-to-day operational performance of a socio-technical system, or can foster learning and organisational change by enabling new understandings gained from experience. In this position paper we argue that technology should be designed to support the reflective capacity of people. There are many interaction designs and artefacts that aim to support problem-solving, but very few that support self-reflection and group reflection. Traditional paradigms for safety-critical systems have focussed on ensuring the functional correctness of designs, minimising the time to complete tasks, etc. Work in the area of user experience design may be of increasing relevance when generating artefacts that aim to encourage reflection

Implications of transforming the Patient Record into a Knowledge Management System

In this paper I theorize about how transforming the interpretative scheme for what a patient record is might restructure a health care setting. The observations presented here were obtained when I during three years followed implications of constructing and computerizing a patient record at three different hospitals. The results were then analyzed and interpreted within a framework combining theories about knowledge management with concepts from structuration theory and cognitive theories about schema-use, representations and sense-making. The findings indicate that thinking about the patient record as a knowledge management system might start a horizontal and vertical movement, a movement of coordination and enhancement. I propose that what the employees want to achieve with the knowledge management system depends on what strategy they have for it.interpretative schemes; anesthesia patient record; knowledge management system; knowledge management; structuration theory

Quality assessment technique for ubiquitous software and middleware

The new paradigm of computing or information systems is ubiquitous computing systems. The technology-oriented issues of ubiquitous computing systems have made researchers pay much attention to the feasibility study of the technologies rather than building quality assurance indices or guidelines. In this context, measuring quality is the key to developing high-quality ubiquitous computing products. For this reason, various quality models have been defined, adopted and enhanced over the years, for example, the need for one recognised standard quality model (ISO/IEC 9126) is the result of a consensus for a software quality model on three levels: characteristics, sub-characteristics, and metrics. However, it is very much unlikely that this scheme will be directly applicable to ubiquitous computing environments which are considerably different to conventional software, trailing a big concern which is being given to reformulate existing methods, and especially to elaborate new assessment techniques for ubiquitous computing environments. This paper selects appropriate quality characteristics for the ubiquitous computing environment, which can be used as the quality target for both ubiquitous computing product evaluation processes ad development processes. Further, each of the quality characteristics has been expanded with evaluation questions and metrics, in some cases with measures. In addition, this quality model has been applied to the industrial setting of the ubiquitous computing environment. These have revealed that while the approach was sound, there are some parts to be more developed in the future

Increasing Retention and Knowledge Transfer Through Digital Storytelling and the Comics Medium: A Design Case

Asynchronous multimedia learning is a common form of delivering training in the workforce industry, and organizations rely on a completion status to measure that training. However, measuring retention and knowledge transfer of new material rarely occurs during asynchronous learning. Grounded in the Visual Language Theory (VLT) and a delivery modality of digital storytelling (DST) suggest that sequential images presented as a visual narrative have higher degrees of retention. Thus, knowledge transfer occurs when learners relate to the narrative and visual applications when engaging with a comics approach to learning. From 2019-2022 a story emerged to design and develop an asynchronous digital storytelling comic narrative about simulation obstetrics training for distribution to 700 nurses in Bihar, India. Chapter 1 introduces digital storytelling and the use of comics in medical education. Chapter 2 explores the literature around visual language theory, digital storytelling, and andragogy in comics. Chapter 3 investigates the initial design beginning in 2018 with the implementation study, to the Simulation Educator Training redesign in 2019. A thorough needs assessment introduces Chapter 4 with learner and context analysis, exposing communication barriers, culture representation, character development, and technology challenges. The initial deployment and subsequent feedback survey in late 2019 resulted in a major redesign beginning in 2020. The following two years resulted in ten comic episodes with shorter seat time, more in-depth explanations of abstract concepts, and interactive scenarios to practice real-world situations. Chapter 5 concludes with lessons learned, opportunities, and closing with the results of a final study conducted in late 2021 and published in February 2022 in the International Journal of Environmental Research and Public Health, resulting in an 86% increase in retention

An Evaluation of Tertiary Educators’ Perception of Online Teaching Related Ergonomic Factors

The Aim of this research was to identify and assess ergonomic factors that affected educators in minerals, mining engineering and other educators’ experience with online teaching. Noise, insufficient time to complete all teaching related work, and lack of interaction with students were the main barriers identified. There was minimal difference in factors between minerals, mining engineering, and other educators’ experiences. Having good physical, organisational, cognitive, social, and environmental ergonomic factors facilitated online educators’ work

Implementing the Use of the Emergency Severity Index Triage Tool in Urgent Care

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has resulted in superior health outcomes such as control of chronic diseases and decreased mortality or worsening symptoms. The ESI triage tool aims to improve patients\u27 triage based on acuity. The triage protocol also has been shown to reduce door-to-provider time, walkouts, and emergent waiting room events. Purpose: The quality improvement project is aimed at evaluating the significance of triage; minimizing door-to-provider times; lowering the risk of potential adverse events in the waiting area; eradicating perceived barriers to implementation, improving patient outcomes throughout the treatment process, and preventing adverse or near-adverse events. Methods: Pre- and post-study design and PDSA model signified the use in this quality improvement project. The principal investigator utilized this design to evaluate the impact of incorporating the Emergency Severity Index triage system into urgent care centers. Results: The average triage time for the pre-intervention and post-intervention periods were calculated separately. Average triage times pre-intervention was noted to be 45 minutes, while post-intervention triage times ranged between 17 and 18 minutes. Post-implementation data showed improvement in all areas, including identifying patients with urgent medical needs, quickly sorting patients in constrained resource settings, allowing triage nurses to project operation and resource needs, and supporting the discrimination of patients who should not be seen in the emergency department. Conclusion: The triage protocol helped reduce door-to-provider time, walkouts, and emergent waiting room events. Implementing the ESI triage tool led to improved clinical practices and decreased wait times and adverse wait room events

Unobtrusive Health Monitoring in Private Spaces: The Smart Home

With the advances in sensor technology, big data, and artificial intelligence, unobtrusive in-home health monitoring has been a research focus for decades. Following up our research on smart vehicles, within the framework of unobtrusive health monitoring in private spaces, this work attempts to provide a guide to current sensor technology for unobtrusive in-home monitoring by a literature review of the state of the art and to answer, in particular, the questions: (1) What types of sensors can be used for unobtrusive in-home health data acquisition? (2) Where should the sensors be placed? (3) What data can be monitored in a smart home? (4) How can the obtained data support the monitoring functions? We conducted a retrospective literature review and summarized the state-of-the-art research on leveraging sensor technology for unobtrusive in-home health monitoring. For structured analysis, we developed a four-category terminology (location, unobtrusive sensor, data, and monitoring functions). We acquired 912 unique articles from four relevant databases (ACM Digital Lib, IEEE Xplore, PubMed, and Scopus) and screened them for relevance, resulting in n=55 papers analyzed in a structured manner using the terminology. The results delivered 25 types of sensors (motion sensor, contact sensor, pressure sensor, electrical current sensor, etc.) that can be deployed within rooms, static facilities, or electric appliances in an ambient way. While behavioral data (e.g., presence (n=38), time spent on activities (n=18)) can be acquired effortlessly, physiological parameters (e.g., heart rate, respiratory rate) are measurable on a limited scale (n=5). Behavioral data contribute to functional monitoring. Emergency monitoring can be built up on behavioral and environmental data. Acquired physiological parameters allow reasonable monitoring of physiological functions to a limited extent. Environmental data and behavioral data also detect safety and security abnormalities. Social interaction monitoring relies mainly on direct monitoring of tools of communication (smartphone; computer). In summary, convincing proof of a clear effect of these monitoring functions on clinical outcome with a large sample size and long-term monitoring is still lacking