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).

Lessons from the Glass Cockpit: Innovation in Alarm Systems to Support Cognitive Work.

Nurses working in the hospital setting increasingly have become overburdened by managing alarms that, in many cases, provide low information value regarding patient health. The current trend, aided by disposable, wearable technologies, is to promote patient monitoring that does not require entering a patient's room. The development of telemetry alarms and middleware escalation devices adds to the continued growth of auditory, visual, and haptic alarms to the hospital environment but can fail to provide a more complete understanding of patient health.

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.

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.

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.

Surgeons' Leadership Styles and Team Behavior in the Operating Room.

Background: The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations.

Protecting patients from an unsafe system: the etiology and recovery of intraoperative deviations in care.

Objective: To understand the etiology and resolution of unanticipated events in the operating room (OR).

Background: The majority of surgical adverse events occur intraoperatively. The OR represents a complex, high-risk system.

Deconstructing intraoperative communication failures.

Background: Communication failure is a common contributor to adverse events. We sought to characterize communication failures during complex operations.

Methods: We video recorded and transcribed six complex operations, representing 22 h of patient care.

War stories: a qualitative analysis of narrative teaching strategies in the operating room.

Background: "War stories" are commonplace in surgical education, yet little is known about their purpose, construct, or use in the education of trainees.

Methods: Ten complex operations were videotaped and audiotaped. Narrative stories were analyzed using grounded theory to identify emergent themes in both the types of stories being told and the teaching objectives they illustrated.

Uncovering the requirements of cognitive work.

Objective: In this article, the author provides an overview of cognitive analysis methods and how they can be used to inform system analysis and design.

Background: Human factors has seen a shift toward modeling and support of cognitively intensive work (e.g.

Impact of clinical reminder redesign on learnability, efficiency, usability, and workload for ambulatory clinic nurses.

Objective: Computerized clinical reminders (CRs) were designed to reduce clinicians' reliance on their memory and to present evidence-based guidelines at point of care. However, the literature indicates that CR adoption and effectiveness has been variable. We examined the impact of four design modifications to CR software on learnability, efficiency, usability, and workload for intake nursing personnel in an outpatient clinic setting.

Making the operating room of the future safer.

There is an increasing demand for interventions to improve patient safety, but there is limited data to guide such reform. In particular, because much of the existing research is outcome-driven, we have a limited understanding of the factors and process variations that influence safety in the operating room. In this article, we start with an overview of safety terminology, suggesting a model that emphasizes "safety" rather than "error" and that can encompass the spectrum of events occurring in the operating room.

A prospective study of patient safety in the operating room.

Background: To better understand the operating room as a system and to identify system features that influence patient safety, we performed an analysis of operating room patient care using a prospective observational technique.

Methods: A multidisciplinary team comprised of human factors experts and surgeons conducted prospective observations of 10 complex general surgery cases in an academic hospital. Minute-to-minute observations were recorded in the field, and later coded and analyzed.

Lessons from a comparison of work domain models: representational choices and their implications.

As methods in cognitive work analysis become more widely applied, questions regarding the impact of modeling choices and similarities in modeling efforts across projects and domains are increasingly relevant. However, no explicit comparison of models of similar systems has been reported. This paper compares independently developed work domain analysis (WDA) models of two command and control environments.

Handoff strategies in settings with high consequences for failure: lessons for health care operations.

Objective: To describe strategies employed during handoffs in four settings with high consequences for failure.

Analysis: of observational data for evidence of use of 21 handoff strategies.

Setting: NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto.