Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

Background: Little is known about how physician time is allocated in ambulatory care.

Objective: To describe how physician time is spent in ambulatory practice.

Design: Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).

Cognitive workload changes for nurses transitioning from a legacy system with paper documentation to a commercial electronic health record.

Objective: Healthcare institutions worldwide are moving to electronic health records (EHRs). These transitions are particularly numerous in the US where healthcare systems are purchasing and implementing commercial EHRs to fulfill federal requirements. Despite the central role of EHRs to workflow, the cognitive impact of these transitions on the workforce has not been widely studied.

Assessing the validity of prospective hazard analysis methods: a comparison of two techniques.

Background: Prospective Hazard Analysis techniques such as Healthcare Failure Modes and Effects Analysis (HFMEA) and Structured What If Technique (SWIFT) have the potential to increase safety by identifying risks before an adverse event occurs. Published accounts of their application in healthcare have identified benefits, but the reliability of some methods has been found to be low. The aim of this study was to examine the validity of SWIFT and HFMEA by comparing their outputs in the process of risk assessment, and comparing the results with risks identified by retrospective methods.

Designing for distractions: a human factors approach to decreasing interruptions at a centralised medication station.

Objective: To decrease interruptions around a centrally-located, centralised, open paediatric medication station.

Methods: Several established human factors methodologies were used to study paediatric medication administration, including cases with 'walk through' and verbal protocols; semi-structured interviews, including critical incident analysis; hierarchical task analysis; and observation.

Results: Inexpensive barriers were constructed that protected the tasks likely to lead to errors if interrupted.

Interruption handling strategies during paediatric medication administration.

Background: Interruptions are a part of many hospital settings. During medication administration, interruptions have been shown to lead to medication errors. Understanding interruption management strategies during medical management could lead to the design of interventions to reduce and mitigate related errors.

Does the process map influence the outcome of quality improvement work? A comparison of a sequential flow diagram and a hierarchical task analysis diagram.

Background: Many quality and safety improvement methods in healthcare rely on a complete and accurate map of the process. Process mapping in healthcare is often achieved using a sequential flow diagram, but there is little guidance available in the literature about the most effective type of process map to use. Moreover there is evidence that the organisation of information in an external representation affects reasoning and decision making.