"Put the what, ? Cut ?!" challenges to coordinating attention in robot-assisted surgery: a microanalytic pilot study.

Introduction: During robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members' ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these constraints.

Objectives: Explore the use of microanalysis to describe and evaluate communicative efficiency in RAS through examination of referencing in surgical tasks.

The active role of interpreters in medical discourse - An observational study in emergency medicine.

Objective: To study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters.

Methods: English proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper.

Evaluating user-personas as supplementary tools in AAC intervention and clinician decision making.

Models used for the design and service delivery of Augmentative and Alternative Communication (AAC) systems are limited. There are no standardized protocols for gathering user requirements beyond clinical/diagnostic information relating to AAC access needs (i.e.

Modeling patient-related workload in the emergency department using electronic health record data.

Introduction: Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study is to use electronic health record (EHR) data to predict the amount of work that individual patients contribute to clinician workload (patient-related workload).

Interaction symmetry: Assessing augmented speaker and oral speaker performances across four tasks.

This investigation examined the impact of speech-generating devices (SGDs) on the interaction dynamics (i.e., symmetry) of augmented speakers and their conversation partners while performing several interaction tasks.

Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication.

Background: The current state of scientific knowledge regarding communication between emergency medicine (EM) providers indicates that communication is critical to safe and effective patient care.

Objectives: In this study, we identified communication needs of EM nurses and physicians; in particular, what information should be conveyed, when, how, and to whom.

Methods: Five semi-structured focus groups and one interview were conducted with nine nurses, eight attending physicians, and four residents.

Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine.

Background: Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care.

Qualitative findings from a pilot stage implementation of a novel organizational learning tool toward operationalizing the Safety-II paradigm in health care.

'Safety-II' is a new approach to safety, which emphasizes learning proactively about how safety and efficacy are achieved in everyday frontline work. Previous research developed a new lesson-sharing tool designed based on the Safety-II approach: Resilience Engineering Tool to Improve Patient Safety (RETIPS). The tool comprises questions designed to elicit narratives of adaptations that have contributed to effectiveness in care delivery.

Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment.

Objective: To characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit.

Methods: We performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members.

Are gestures worth a thousand words? Verbal and nonverbal communication during robot-assisted surgery.

Communication breakdowns in the operating room (OR) have been linked to errors during surgery. Robot-assisted surgery (RAS), a new surgical technology, can lead to new challenges in communication owing to the remote location of the surgeon away from the patient and bedside assistants. Nevertheless, few studies have studied communication strategies during RAS.

Human factors in robotic assisted surgery: Lessons from studies 'in the Wild'.

This article reviews studies conducted "in the wild" that explore the "ironies of automation" in Robotic Assisted Surgery (RAS). Workload may be reduced for the surgeon, but increased for other team members, with postural stress relocated rather than reduced, and the introduction of a range of new challenges, for example, in the need to control multiple arms, with multiple instruments; and the increased demands of being physically separated from the team. Workflow disruptions were not compared with other surgeries; however, the prevalence of equipment and training disruptions differs from other types of surgeries.

The impact of team characteristics and context on team communication: An integrative literature review.

Many studies on teams report measures of team communication; however, these studies vary widely in terms of the team characteristics, situations, and tasks studied making it difficult to understand impacts on team communication more generally. The objective of this review is systematically summarize relationships between measures of team communication and team characteristics and situational contexts. A literature review was conducted searching in four electronic databases (PsycINFO, MEDLINE, Ergonomics Abstracts, and SocINDEX).

Communication in the Electronic Age: an Analysis of Face-to-Face Physician-Nurse Communication in the Emergency Department.

We describe the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. Emergency medicine physicians and nurses were observed for 2 h periods. Researchers used paper notes to document the characteristics (e.

Low-Cost Sensor System Design for In-Home Physical Activity Tracking.

An aging and more sedentary population requires interventions aimed at monitoring physical activity, particularly within the home. This research uses simulation, optimization, and regression analyses to assess the feasibility of using a small number of sensors to track movement and infer physical activity levels of older adults. Based on activity data from the American Time Use Survey and assisted living apartment layouts, we determined that using three to four doorway sensors can be used to effectively capture a sufficient amount of movements in order to estimate activity.

Usability evaluation of an emergency department information system prototype designed using cognitive systems engineering techniques.

This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the display's ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components.

Cognitive engineering and health informatics: Applications and intersections.

Cognitive engineering is an applied field with roots in both cognitive science and engineering that has been used to support design of information displays, decision support, human-automation interaction, and training in numerous high risk domains ranging from nuclear power plant control to transportation and defense systems. Cognitive engineering provides a set of structured, analytic methods for data collection and analysis that intersect with and complement methods of Cognitive Informatics. These methods support discovery of aspects of the work that make performance challenging, as well as the knowledge, skills, and strategies that experts use to meet those challenges.

Assessment of Innovative Emergency Department Information Displays in a Clinical Simulation Center.

The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-physician teams performed simulated emergency department tasks. Questionnaires were used to assess the cognitive support provided by the displays, participants' level of situation awareness, and participants' workload during the simulated tasks.

Usability in Health IT: Beyond Compliance to Meaningful Design and Assessment.

The relatively rapid transition from a paper-based system to a digital system in healthcare has not always employed a sophisticated integration of usability concepts. Yet usability is critical to safety and to effectiveness of the electronic health record, and regulators and policy makers have been increasingly focused on this area. This panel will provide a variety of perspectives on this important issue, ranging from a description of the problem based on current vendor usability practices; recommendations regarding domain content rich usability processes including use cases, assessments, and scenarios; and the extension of usability assessments and design improvements to post-system implementation.

Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.

Importance And Objectives: As health information technologies become more prevalent in physician workflow, it is increasingly important to understand how physicians are using and interacting with these systems. This includes understanding how physicians search for information presented through health information technology systems. Eye tracking technologies provide a useful technique to understand how physicians visually search for information.

The Loud Surgeon Behind the Console: Understanding Team Activities During Robot-Assisted Surgery.

Objectives: To design a data collection methodology to capture team activities during robot-assisted surgery (RAS) (team communications, surgical flow, and procedural interruptions), and use relevant disciplines of Industrial Engineering and Human Factors Engineering to uncover key issues impeding surgical flow and guide evidence-based strategic changes to enhance surgical performance and improve outcomes.

Design: Field study, to determine the feasibility of the proposed methodology.

Setting: Recording the operating room (OR) environment during robot-assisted surgeries (RAS).

Evaluation and Impact of Workflow Interruptions During Robot-assisted Surgery.

Objective: To analyze and categorize causes for interruptions during robot-assisted surgery.

Methods: We analyzed 10 robot-assisted prostatectomies that were performed by 3 surgeons from October 2014 to June 2015. Interruptions to surgery were defined in terms of duration, stage of surgery, personnel involved, reasons, and impact of the interruption on the surgical workflow.

Ambulatory movements, team dynamics and interactions during robot-assisted surgery.

Objective: To analyse ambulatory movements and team dynamics during robot-assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events.

Methods: With institutional review board approval, we retrospectively reviewed 10 recorded robot-assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose.

Team interaction during surgery: a systematic review of communication coding schemes.

Background: Communication problems have been systematically linked to human errors in surgery and a deep understanding of the underlying processes is essential. Although a number of tools exist to assess nontechnical skills, methods to study communication and other team-related processes are far from being standardized, making comparisons challenging. We conducted a systematic review to analyze methods used to study events in the operating room (OR) and to develop a synthesized coding scheme for OR team communication.

An evidence-based toolkit for the development of effective and sustainable root cause analysis system safety solutions.

Root cause analysis (RCA) after adverse events in healthcare is a standard practice at many institutions. However, healthcare has failed to see a dramatic improvement in patient safety over the last decade. In order to improve the RCA process, this study used systems safety science, which is based partly on human factors engineering principles and has been applied with success in other high-risk industries like aviation.