A Human Factors Approach for Identifying Latent Failures in Healthcare Settings

INTRODUCTION: The purpose of the current research was to assess the utility of the Human Factors Analysis and Classification System (HFACS), a tool that has historically been used reactively to look at accidents and incidents, for classifying observational data from various healthcare venues. METHOD: Three studies are presented to investigate the reliability of HFACS for classifying observational data. In Study I, HFACS was applied to observational human factors data collected from the cardiovascular operating room (CVOR) at an academic medical university. Three trained analysts categorized the data using HFACS and several approaches were used to evaluate its reliability during the categorization task. The same method was repeated for Study II, which utilized CVOR data collected from a non-academic hospital. To investigate the ability of HFACS for differentiating between hospitals, the data from the academic and non-academic hospitals were compared. Finally, to explore the utility of HFACS in another venue, Study III employed the same approach as Study I and II however, observational data from a trauma center was utilized. RESULTS: Results of the three studies revealed that the framework was substantially reliable (k=0.635 (95% CI, .611-.659), p = 0.000; k =0.642 (95% CI, .633-.652), p = 0.000; k=0.680 (95% CI, .662 to .698), p = 0.000) for classifying observational healthcare data. In all three data sets, preconditions for unsafe acts were the most common area of systemic weakness. However, differences in the distributions of these categories did exist when data-sets were compared. CONCLUSION: This study is a first step in establishing the reliability of the HFACS framework as a tool for classifying observational human factors data. As HFACS appears to be a reliable observation tool, findings associated with its use could help to identify where errors and adverse events are likely to occur. Therefore, the proactive identification of human factors issues associated with patient harm represents the next step in the evolution of patient safety. Predictably, hospital administrators could put in place targeted interventions to help mitigate human factors issues before they manifest and become harmful events in the future

Ultra- and Hyper-compact HII regions at 20 GHz

We present radio and infrared observations of 4 hyper-compact HII regions and 4 ultra-compact HII regions in the southern Galactic plane. These objects were selected from a blind survey for UCHII regions using data from two new radio surveys of the southern sky; the Australia Telescope 20 GHz survey (AT20G) and the 2nd epoch Molonglo Galactic Plane Survey (MGPS-2) at 843 MHz. To our knowledge, this is the first blind radio survey for hyper- and ultra-compact HII regions. We have followed up these sources with the Australia Telescope Compact Array to obtain H70-alpha recombination line measurements, higher resolution images at 20 GHz and flux density measurements at 30, 40 and 95 GHz. From this we have determined sizes and recombination line temperatures as well as modeling the spectral energy distributions to determine emission measures. We have classified the sources as hyper-compact or ultra-compact on the basis of their physical parameters, in comparison with benchmark parameters from the literature. Several of these bright, compact sources are potential calibrators for the Low Frequency Instrument (30-70 GHz) and the 100-GHz channel of the High Frequency Instrument of the Planck satellite mission. They may also be useful as calibrators for the Australia Telescope Compact Array, which lacks good non-variable primary flux calibrators at higher frequencies and in the Galactic plane region. Our spectral energy distributions allow the flux densities within the Planck bands to be determined, although our high frequency observations show that several sources have excess emission at 95 GHz (3 mm) that can not be explained by current models.Comment: 13 pages, 7 figures, accepted for publication in MNRA

Planning an Escape: Considerations for the Development of Applied Escape Rooms

Background. Teams are essential to a wide array of applications and organizations often utilize varying interventions to improve the effectiveness of their teams. Due to their collaborative and modifiable characteristics, escape rooms are being increasingly utilized as an avenue to both deliver team interventions and to function as testbeds in research. Escape rooms are complex, interdependent activities which warrant careful planning to be effectively implemented. Despite the growing literature base concerning escape rooms, there is still limited practical guidance to inform the development of an escape room. Aim. The purpose of this article is to provide seven considerations that are relevant to the development, implementation, and effectiveness of an escape room. Specifically, guidance is provided in determining the objectives, identifying a theme, assigning the roles, establishing participant interdependence, selecting a venue, designing the puzzles, and creating the assessments. Conclusion. The considerations provided in this article can advance the science underlying the use of escape rooms and preclude difficulties associated with their use

Advancing Team Cohesion: Using an Escape Room as a Novel Approach

Objective: An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods: This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post- escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results: Sixty-two teams participated (n 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) 24.10, p \u3c .001; Wilks’ K .725; partial g2 .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions: This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums

Prognosis Does not Change the Landscape: Palliative Home Care Clients Experience High Rates of Pain and Nausea, Regardless of Prognosis

Background: Most individuals who typically receive palliative care (PC) tend to have cancer and a relatively short prognosis (\u3c 6 months). People with other life-limiting illnesses can also benefit from a palliative care approach. However, little is known about those who receive palliative home care in Ontario, Canada\u27s largest province. To address this gap, the goal of this project was to understand the needs, symptoms and potential differences between those with a shorter (\u3c 6 months) and longer prognosis (6+ months) for individuals receiving PC in the community. Methods: A cross-sectional analysis was conducted using interRAI Palliative Care (interRAI PC) assessment data collected between 2011 and 2018. Individuals with a shorter prognosis (\u3c 6 months; n = 48,019 or 64.1%) were compared to those with a longer prognosis (6+ months; n = 26,945) across several clinical symptoms. The standardized difference (stdiff), between proportions, was calculated to identify statistically meaningful differences between those with a shorter and longer prognosis. Values of the stdiff of 0.2 or higher (absolute value) indicated a statistically significant difference. Results: Overall, cancer was the most prevalent diagnosis (83.2%). Those with a shorter prognosis were significantly more likely to experience fatigue (75.3% vs. 59.5%; stdiff = 0.34) and shortness of breath at rest (22.1% vs. 13.4%; stdiff = 0.23). However, the two groups were similar in terms of severe pain (73.5% vs. 66.5%; stdiff = - 0.15), depressive symptoms (13.2% vs. 10.7%; stdiff = 0.08) and nausea (35.7% vs. 29.4%; stdiff = 0.13). Conclusions: These results highlight the importance of earlier identification of individuals who could benefit from a palliative approach to their care as individuals with a longer prognosis also experience high rates of symptoms such as pain and nausea. Providing PC earlier in the illness trajectory has the potential to improve an individual\u27s overall quality of life throughout the duration of their illness

Unlocking the Methodology Of Escape Rooms: Considerations For Conducting Applied Escape Rooms in Research

Background. Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose. The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion. The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data

Vestibular-Somatosensory Convergence in Head Movement Control During Locomotion after Long-Duration Space Flight

Exposure to the microgravity conditions of space flight induces adaptive modification in the control of vestibular-mediated reflexive head movement during locomotion after space flight. Space flight causes astronauts to be exposed to somatosensory adaptation in both the vestibular and body load-sensing (BLS) systems. The goal of these studies was to examine the contributions of vestibular and BLS-mediated somatosensory influences on head movement control during locomotion after long-duration space flight. Subjects were asked to walk on a treadmill driven at 1.8 m/s while performing a visual acuity task. Data were collected using the same testing protocol from three independent subject groups; 1) normal subjects before and after exposure to 30 minutes of 40% bodyweight unloaded treadmill walking, 2) bilateral labyrinthine deficient (LD) patients and 3) astronauts who performed the protocol before and after long duration space flight. Motion data from head and trunk segmental motion data were obtained to calculate the angular head pitch (HP) movements during walking trials while subjects performed the visual task, to estimate the contributions of vestibular reflexive mechanisms in HP movements. Results showed that exposure to unloaded locomotion caused a significant increase in HP movements, whereas in the LD patients the HP movements were significantly decreased. Astronaut subjects results showed a heterogeneous response of both increases and decreases in the amplitude of HP movement. We infer that BLS-mediated somatosensory input centrally modulates vestibular input and can adaptively modify head-movement control during locomotion. Thus, space flight may cause a central adaptation mediated by the converging vestibular and body load-sensing somatosensory systems