Application of Human Factors in Neonatal Intensive Care Unit Redesign.

Only recently has physical space design become more widely recognized as playing a critical role in delivery of care, with an emerging body of literature on the application of human factors approaches to design and evaluation. This chapter describes the use of human factors approaches to develop and conduct an evaluation of a proposed Neonatal Intensive Care Unit redesign in a Midwestern children's hospital. Methods included observations and knowledge elicitation from stakeholders to characterize their goals, challenges, and needs.

Developing a Cognitive and Communications Tool for Burn Intensive Care Unit Clinicians.

Background: Burn Intensive Care Unit (BICU) work is necessarily complex and depends on clinician actions, resources, and variable patient responses to interventions. Clinicians use large volumes of data that are condensed in time, but separated across resources, to care for patients. Correctly designed health information technology (IT) systems may help clinicians to treat these patients more efficiently, accurately, and reliably.

Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.

Background: Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients.

Purpose: To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU.

Methods: Qualitative case study design using a cognitive task analysis interviewing approach.

The mixed blessings of smart infusion devices and health care IT.

From July to October 2009, a team of human factors researchers evaluated the use of a commercially available infusion device among nurses at a tertiary care hospital in the Midwest. The study's purpose was to determine the factors that may influence the adoption and "best practice" use of smart infusion devices by identifying the human, technological, environmental, and/or organizational factors and to describe how they support or impede safe practices. The study's aim was to show how technology and individual and team behavior influence each other, as well as care performance and outcomes.

Relation of repeated low-level blast exposure with symptomology similar to concussion.

Objective: To investigate anecdotal reports suggesting that repeated exposure to low-level explosive blast has myriad health impacts, including an array of neurological effects.

Participants: A total of 184 anonymous survey respondents from military and nonmilitary law enforcement populations (135 exposed to occupational blast and 49 controls).

Design: Survey of self-reported history of occupational exposure to repeated low-level blast (breaching blast) and symptomology similar to concussion.

Characterizing novice-expert differences in macrocognition: an exploratory study of cognitive work in the emergency department.

Study Objective: The objectives of this study are to elicit and document descriptions of emergency physician expertise, to characterize cognitive differences between novice and expert physicians, and to identify areas in which novices' skill and knowledge gaps are most pronounced. The nature of the differences between novices and experts needs to be explored to develop effective instructional modalities that accelerate the learning curve of inexperienced physicians who work in high-complexity environments.

Methods: We interviewed novice emergency physicians (first-year residents) and attending physicians with significant expertise, working in an academic Level I trauma center in Southern California.

Critical care physician cognitive task analysis: an exploratory study.

Introduction: For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, the workflow of every physician team in every academic medical centre has been irrevocably altered. We explored the use of cognitive task analysis (CTA) techniques, most commonly used in other high-stress and time-sensitive environments, to analyse key cognitive activities in critical care medicine.