Service-Oriented Architectures for Safety-Critical Systems

Many organisations in the safety-critical domain are service-oriented, fundamentally centred on critical services provided by systems and operators. Increasingly, these services rely on software-intensive systems, e.g. medical health informatics and air traffic control, for improving the different aspects of industrial practice, e.g. enhancing efficiency through automation and safety through smart alarm systems. However, many services are categorised as high risk and as such it is vital to analyse the ways in which the software-based systems can contribute to unintentional harm and potentially compromise safety. This thesis defines an approach to modelling and analysing Service-Oriented Architectures (SOAs) used in the safety-critical domain, with emphasis on identifying and classifying potential hazardous behaviour. The approach also provides a systematic and reusable basis for defining how the safety case for these SOAs can be developed in a modular manner. The approach is tool-supported and is evaluated through two case studies, from the healthcare and oil and gas domains, and industrial review

Integrating Safety Assessment into the Design of Healthcare Service-Oriented Architectures

Most healthcare organisations are service-oriented, fundamentally centred on critical services provided by medical and nursing staff. Increasingly, these human-centric services rely on software-intensive systems, i.e. medical devices and health informatics, for improving different aspects of healthcare, e.g. enhancing efficiency through automation and patient safety through smart alarm systems. However, many healthcare services are categorised as high risk and as such it is vital to analyse the ways in which the software-based systems can contribute to unintentional harm and potentially compromise patient safety. This paper proposes an approach to modelling and analysing Service-Oriented Architectures (SOAs) used in healthcare, with emphasis on identifying and classifying potential hazardous behaviour. The paper also considers how the safety case for these SOAs can be developed in a modular manner. The approach is illustrated through a case study based on three services: ambulance, electronic health records and childbirth services

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely