Human factors considerations in designing for infection prevention and control in neonatal care – findings from a pre-design inquiry

Qualitative data collection methods drawn from the early stages of human-centred design frameworks combined with thematic analysis were used to develop an understanding of infection prevention practice within an existing neonatal intensive care unit. Findings were used to generate a framework of understanding which in turn helped inform a baseline approach for future research and design development. The study revealed that a lack of clarity between infection transmission zones and a lack of design attributes needed to uphold infection prevention measures may be undermining healthcare workers’ understanding and application of good practice. The issue may be further complicated by well-intentioned behavioural attitudes to meeting work objectives; undue influences from spatial constraints; the influence of inadvertent and excessive touch-based interactions; physical and/or cognitive exertion to maintain transmission barriers; and the impact of expanding job design and increased workload to supplement for lack of effective barriers

Effects of a computerized cardiac teletriage decision support system on nurse performance: results of a controlled human factors experiment using a mid-fidelity prototype

A gap exists in cardiac care between known best practices and the actual level of care administered. To help bridge this gap, a proof of concept interface for a PDA-based decision support system (DSS) was designed for cardiac care nurses engaged in teletriage. This interface was developed through a user-centered design process. Quality of assessment, quality of recommendations, and number of questions asked were measured. Cardiac floor nurses' assessment quality performance, but not their recommendation quality performance, improved with the DSS. Nurses asked more questions with the DSS than without it, and these additional questions were predominantly classifiable as essential or beneficial to a good assessment. The average participant satisfaction score with the DSS was above neutral

Transferring Patient Care: Patterns of Synchronous Bidisciplinary Communication Between Physicians and Nurses During Handoffs in a Critical Care Unit

Purpose: The transfer of patient care from one health care worker to another involves communication in high-pressure contexts that are often vulnerable to error. This research project captured current practices for handoffs during the critical care stage of surgical recovery in a hospital setting. The objective was to characterize information flowduring transfer and identify patterns of communication between nurses and physicians. Design and Methods: Observations were used to document communication exchanges. The data were analyzed qualitatively according to the types of information exchanged and verbal behavior types. Findings: Reporting and questions were the most common verbal behaviors, and retrospective medical information was the focus of information exchange. The communication was highly interactive when discussing patient status and future care plans. Nurses proactively asked questions to capture a large proportion of the information they needed. Conclusions: Findings reflect positive and constructive patterns of communication during handoffs in the observed hospital unit

Exploring similarities and differences in teamwork across diverse healthcare contexts using communication analysis

Teamwork is prevalent in many work contexts. This study explored the similarities and differences in teamwork processes across different healthcare work contexts with the aim of assessing knowledge transfer feasibility. The research approach was to aggregate team communication analyses from four healthcare contexts to uncover teamwork similarities and differences. The four healthcare contexts included two handoffs and two surgery contexts. The communication analysis segmented communication into meaningful sequences. It categorized utterances into content categories and verbal behaviors. There were a few similar content categories across the four contexts. A clear information structure emerged in the two handoff contexts. In addition, there were more dialogues and requests in the surgeries compared to more reports in the handoffs. The content similarities suggest that some knowledge is transferable among the contexts. However, the differences in communication patterns reflect fundamental differences between handoff and surgery contexts in some teamwork processes. This research demonstrated that using communication analysis can uncover similarities and differences in team cognition and teamwork processes across work contexts. This in turn can help determine what knowledge and methods pertaining to team training, procedures, and technology are transferable across the contexts

Communication and team situation awareness in the OR: Implications for augmentative information display

Team Situation Awareness (TSA) is one of the critical factors in effective Operating Room (OR) teamwork and can impact patient safety and quality of care. While previous research showed a relationship between situation awareness, as measured by communication events, and team performance, the implications for developing technology to augment and facilitate TSA were not examined. This research aims to further study situation-related communications in the cardiac OR in order to uncover potential degradation in TSA which may lead to adverse events. The communication loop construct-the full cycle of information flow between the participants in the sequence-was used to assess susceptibility to breakdown. Previous research and the findings here suggest that communication loops that are open, non-directed, or with delayed closure, can be susceptible to information loss. These were quantit

A communication analysis methodology for developing a cardiac operating room team-oriented display

This paper outlines an empirical method to analyze human communication in the context of a cardiac Operating Room (OR) and derive design requirements for a team-oriented information display. Its first phase was to identify and categorize shared information within teamwork. The subsequent analysis of the shared information included aggregating shared information instances into unique items, and then scoping and generating the display requirements. The analysis resulted in 52 unique shared information items out of 845 information sharing instances. These unique information items were considered as the requirements for a cardiac OR team-oriented display. While the method was implemented on operating room teamwork, it can be generalized to a variety of domains with a need for a team-oriented display

Healthcare providers' perceptions of a situational awareness display for emergency department resuscitation: A simulation qualitative study

Importance: Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. Objectives: To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. Design: We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants. Setting: Dual site tertiary care level 1 trauma centre in Ottawa, Canada. Participants: We recruited by email physicians, nurses and respiratory therapist. Intervention: Situational Awareness Display, a visual cognitive aid that provides key clinical information to enhance resuscitation team communication and situational awareness. Main outcomes and measures: Themes emerging from focus groups and simulation debriefs. Three reviewers independently coded and analysed transcripts using content qualitative analysis. Results: We recruited a total of 33 participants in two focus groups (n = 20) and six simulation debriefs with three 4-5 member teams (n = 13). Majority of participants (10/13) strongly endorsed the Situational Awareness Display's utility in simulation (very or extremely useful). Focus groups and debrief themes included improved perception of patient data, comprehension of context and ability to project to future decisions. Participants described potentially positive and negative impacts on patient safety and positive impacts on provider performance and team communication. Participants expressed a need for easy data entry incorporated into clinical workflow and training on how to use the display. Conclusion: Emergency resuscitation team participants felt the Situational Awareness Display has potential to improve provider performance, team communication and situational awareness, ultimately enhancing quality of care