Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

<p>Abstract</p> <p>Background</p> <p>Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.</p> <p>Methods</p> <p>Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.</p> <p>Results</p> <p>We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.</p> <p>Conclusions</p> <p>Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.</p

Distributed Prospective Memory: An approach to understanding how nurses remember tasks

People’s ability to execute future intentions, or their prospective memory (PM), is a critical aspect of cognitive work because failures can have adverse outcomes. Most research to date deals with unaided prospective memory performance outside a healthcare context. We report results from a field study investigating PM performance of intensive care nurses. Concepts from distributed cognition help to identify how nurses use physical properties of their working environment to manage PM demands. Results show that (1) PM demands can be classified using a taxonomy from aviation and (2) nurses are supported by and use properties of the environment to manage PM demands. Focusing on distributed support for prospective memory lets us study prospective memory in rich work contexts. The results inform health information system and device design and professional education

Effects of interruptions on prospective memory performance in anesthesiology

Interruptions have been associated with adverse events in healthcare. However, supporting studies are descriptive and atheoretical rather than explanatory, and they seldom show that interruptions compromise patient safety. Prospective memory may provide useful theoretical background. We analyzed video from a full-scale patient simulator for factors enhancing or inhibiting anesthesiologists' prospective memory performance. The critical task was to remember to cross check a unit of blood against the patient before administering the blood. All 12 participants were interrupted by the surgeon when the blood arrived. Only participants who self-initiated the retrieval (n = 3), or returned their full attention to the transfusion task and saw the blood bag label (n = 7), remembered the check. The result can be explained with findings from prospective memory literature

Interruptions and blood transfusion checks: lessons from the simulated operating room

Interruptions occur frequently in the operating room with both positive and negative consequences. Interruptions can distract anesthesiologists from safety-critical tasks, such as the pretransfusion blood check. In a simulated operating room, 12 anesthesiologists requested blood as part of a "bleeding patient" scenario. They were distracted while their assistant accepted delivery of the product and began transfusing without performing the standard check. Anesthesiologists who immediately engaged with the interruption failed to notice the omission, whereas those who rejected or deferred the interruption all noted and remedied the omitted check (P < 0.05). We discuss the role of displays and strategies on safety