Human Factors Engineering for the Pediatric Hospitalist.

As pediatrics hospitalists, we care for a diverse population of hospitalized children with increasing acuity and complexity in large, multidisciplinary medical teams. In this Method/ology paper, we summarize how human factors engineering (HFE) can provide a framework and tools to help us understand and improve our complex care processes and resulting outcomes. First, we define and discuss the 3 domains of HFE (ie, physical, cognitive, and organizational) and offer examples of HFE's application to pediatric hospital medicine.

Sociotechnical system design to support disaster intervention development teams.

Teams are critical in developing effective responses to various disasters and crises. This study defines a new type of response team: a disaster intervention development team, charged with rapidly developing emergent and innovative interventions to aid disaster response. In this case study, we analyzed the SHIELD Enterprise, a disaster intervention development team that developed and deployed a diagnostic testing system for community surveillance and diagnosis to respond to the COVID-19 infectious disease outbreak.

Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes.

Objective: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related.

Background: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts.

Interactions in Sociotechnical Systems: Achieving Balance in the Use of an Augmented Reality Mobile Application.

Objective: We explore relationships between barriers and facilitators experienced by users to understand dynamic interactions in sociotechnical systems and improve a mobile phone-based augmented reality application that teaches users about the contents of a standardized pediatric code cart.

Background: Understanding interactions between performance obstacles and facilitators can provide guidance to (re)designing sociotechnical systems to improve system outcomes. Clinicians should know about contents and organization of code carts, and an augmented reality mobile application may improve that knowledge but changes the sociotechnical system in which they learn.

Human Factors and Ergonomics (HFE) applications in responses to the COVID-19 pandemic: Lessons learned and considerations for methods.

Human Factors and Ergonomics (HFE), with the goal to support humans through system design, can contribute to responses to emergencies and crises, like the COVID-19 pandemic. In this paper, we describe three cases presented at the 21st Triennial Congress of the International Ergonomics Association to demonstrate how HFE has been applied during the COVID-19 pandemic, namely to (1) develop a mobile diagnostic testing system, (2) understand the changes within physiotherapy services, and (3) guide the transition of a perioperative pain program to telemedicine. We reflect on methodological choices and lessons learned from each case and discuss opportunities to expand the impact of HFE in responses to future emergencies.

Care transition of trauma patients: Processes with articulation work before and after handoff.

While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork.

Walking the line: balancing performance barriers and facilitators in an augmented reality mobile application for paediatric code cart training.

An augmented reality (AR) mobile smartphone application was developed for clinicians to improve their knowledge about the contents and organisation of a standardised paediatric code cart, an important tool in safe, effective paediatric resuscitations. This study used focus groups and interviews with 22 clinicians to identify work system barriers and facilitators to use of the application. We identified twelve dimensions of barriers and facilitators: convenience, device ownership, device size and type, gamification, interface design, movement/physical space, perception of others, spatial presence, technological experience, technological glitches, workload, and the perception and attitude towards code cart and resuscitation.

Emergency ventilator for COVID-19.

The COVID-19 pandemic disrupted the world in 2020 by spreading at unprecedented rates and causing tens of thousands of fatalities within a few months. The number of deaths dramatically increased in regions where the number of patients in need of hospital care exceeded the availability of care. Many COVID-19 patients experience Acute Respiratory Distress Syndrome (ARDS), a condition that can be treated with mechanical ventilation.

Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.

Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU.

Information flow during pediatric trauma care transitions: things falling through the cracks.

Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Every year, nearly 10 million children are evaluated in emergency departments (EDs) for traumatic injuries, resulting in 250,000 hospital admissions and 10,000 deaths. Pediatric trauma care in hospitals is distributed across time and space, and particularly complex with involvement of large and fluid care teams.

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care.

Objective: To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma.

Methods: We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline.

Quantifying the Qualitative with Epistemic Network Analysis: A Human Factors Case Study of Task-Allocation Communication in a Primary Care Team.

Health care is fundamentally about people, and therefore, engineering approaches for studying healthcare systems must consider the perspective, concepts and methods offered by the human factors and ergonomics (HFE) discipline. HFE analysis is often qualitative to provide in-depth description of work systems and processes. To deepen our understanding of care processes, we propose the next level of analysis, i.

SEIPS-based process modeling in primary care.

Process mapping, often used as part of the human factors and systems engineering approach to improve care delivery and outcomes, should be expanded to represent the complex, interconnected sociotechnical aspects of health care. Here, we propose a new sociotechnical process modeling method to describe and evaluate processes, using the SEIPS model as the conceptual framework. The method produces a process map and supplementary table, which identify work system barriers and facilitators.