Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.

Objectives: Enhanced recovery pathways (ERPs) are evidence-based approaches to improving perioperative surgical care. However, the role of electronic health records (EHRs) in their implementation is unclear. We examine how EHRs facilitate or hinder ERP implementation.

Implementing Enhanced Recovery Pathways: A Qualitative Study of Factors That Distinguished Higher Performing Hospitals.

Objective: The aim of this study was to explore barriers and facilitators to implementing enhanced recovery pathways, with a focus on identifying factors that distinguished hospitals achieving greater levels of implementation success.

Background: Despite the clinical effectiveness of enhanced recovery pathways, the implementation of these complex interventions varies widely. While there is a growing list of contextual factors that may affect implementation, little is known about which factors distinguish between higher and lower levels of implementation success.

The TeamSTEPPS for Improving Diagnosis Team Assessment Tool: Scale Development and Psychometric Evaluation.

Introduction: One in three patients is affected by diagnosis-related communication failures. Only a few valid and reliable instruments that measure teamwork and communication exist, and none of those focus on improving diagnosis. The authors developed, refined, and psychometrically evaluated the TeamSTEPPS for Improving Diagnosis Team Assessment Tool (TAT), which assesses diagnostic teamwork and communication in five critical teamwork domains and can be used to identify strengths and opportunities for improvement and monitor performance.

Critical Behaviors for Perioperative Improvement Teams.

Effectively leading perioperative safety and quality improvement requires a multidisciplinary team approach. However, leaders are often left without clear guidance on how to assemble and manage teams in these settings. We employ a Delphi process to prioritize specific behavioral strategies surgical safety and quality leaders can use to improve their chances of success implementing improvement efforts.

Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process.

Objectives: Achieving diagnostic excellence on medical wards requires teamwork and effective team dynamics. However, the study of ward team dynamics in teaching hospitals is relatively underdeveloped. We aim to enhance understanding of how ward team members interact in the diagnostic process and of the underlying behavioral, psychological, and cognitive mechanisms driving team interactions.

Use of a Real-Time Locating System to Assess Internal Medicine Resident Location and Movement in the Hospital.

Importance: The patient-physician clinical encounter is the cornerstone of medical training, yet residents spend as little as 12% of their time in direct patient contact.

Objectives: To use a real-time locating system (RTLS) to characterize intern work experiences in the hospital, understand factors associated with time spent at patients' bedsides, and inform future interventions to increase time spent with patients.

Design, Setting, And Participants: This cross-sectional study was conducted from July 1, 2018, to June 30, 2019 (ie, the academic year 2018-2019).

Human Factors and Ergonomics in Healthcare: Industry Demands and a Path Forward.

This article reviews three industry demands that will impact the future of Human Factors and Ergonomics in Healthcare settings. These demands include the growing population of older adults, the increasing use of telemedicine, and a focus on patient-centered care. Following, we discuss a path forward through improved medical teams, error management, and safety testing of medical devices and tools.

Demographic and technological factors influencing virtual seizure clinic visit satisfaction before and during the Covid-19 pandemic in rural Hawaii.

Background: Telemedicine clinic visits traditionally originated from spoke clinic sites, but recent trends have favored home-based telemedicine, particularly in the time of Covid-19. Our study focused on identification of barriers and factors influencing perceptions of care with use of home-based telemedicine in patients with seizures living in rural Hawaii. We additionally compared characteristics of patients using telemedicine versus in-person clinic visits prior to the Covid-19 pandemic.

Smart agent system for insulin infusion protocol management: a simulation-based human factors evaluation study.

Objective: To compare the insulin infusion management of critically ill patients by nurses using either a common standard (ie, human completion of insulin infusion protocol steps) or smart agent (SA) system that integrates the electronic health record and infusion pump and automates insulin dose selection.

Design: A within subjects design where participants completed 12 simulation scenarios, in 4 blocks of 3 scenarios each. Each block was performed with either the manual standard or the SA system.

Team Physiological Dynamics: A Critical Review.

Objective: Review the use of physiological measurement in team settings and propose recommendations to improve the state of the science.

Background: New sensor and analytical capabilities enable exploration of relationships between team members' physiological dynamics. We conducted a review of physiological measures used in research on teams to understand (1) how these measures are theoretically and operationally related to team constructs and (2) what types of validity evidence exist for physiological measurement in team settings.

Human Factors Evaluation of the Universal Anaesthesia Machine: Assessing Equipment with High-Fidelity Simulation Prior to Deployment in a Resource-Constrained Environment.

Background: Anesthesia providers in low- and middle-income countries face many challenges, including poor availability of functioning equipment designed to meet their environmental, organizational, and resource constraints. These are serious global health disparities which threaten access to care and patient safety for those who receive surgical care. In this study, we conducted a simulation-based human factors analysis of the Universal Anaesthesia Machine (UAM®), a device designed to support anesthesia providers in austere medical settings.

Reducing Three Infections Across Cardiac Surgery Programs: A Multisite Cross-Unit Collaboration.

Using a pre-post design, this study examined the impact of a multifaceted program to simultaneously improve 3 health care-associated infections and patient safety culture throughout the cardiac surgery service line in 11 hospitals. Interventions included the Comprehensive Unit-based Safety Program to improve safety culture and evidence-based bundles to prevent central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP). CLABSIs and SSIs showed a downward trend over 2 years, then the rates returned to levels similar to baseline in the third year.

Managing creativity and compliance in the pursuit of patient safety.

Background: Are creativity and compliance mutually exclusive? In clinical settings, this question is increasingly relevant. Hospitals and clinics seek the creative input of their employees to help solve persistent patient safety issues, such as the prevention of bloodstream infections, while simultaneously striving for greater adherence to evidence-based guidelines and protocols. Extant research provides few answers about how creativity works in such contexts.

Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.

Aim: To assess the utility of using external databases for quality improvement (QI) evaluations in the context of an innovative QI collaborative aimed to reduce three infections and improve patient safety across the cardiac surgery service line.

Methods: We compared changes in each outcome between 15 intervention hospitals (infection reduction protocols plus safety culture intervention) and 52 propensity score-matched hospitals (feedback only).

Results: Improvement trends in several outcomes among the intervention hospitals were not statistically different from those in comparison hospitals.

Human factors-based risk analysis to improve the safety of doffing enhanced personal protective equipment.

Objective: To systematically assess enhanced personal protective equipment (PPE) doffing safety risks.

Design: We employed a 3-part approach to this study: (1) hierarchical task analysis (HTA) of the PPE doffing process; (2) human factors-informed failure modes and effects analysis (FMEA); and (3) focus group sessions with a convenience sample of infection prevention (IP) subject matter experts.

Setting: A large academic US hospital with a regional Special Pathogens Treatment Center and enhanced PPE doffing protocol experience.

A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals.

Objective: To compare the Agency for Healthcare Research and Quality's Quality and Safety Review System (QSRS) and the proposed triadic structure for the 11th version of the International Classification of Disease (ICD-11) in their ability to capture adverse events in U.S. hospitals.

Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.

Objective: To establish the validity of sensor-based measures of work processes for predicting perceived mental and physical exertion of critical care nurses.

Materials And Methods: Repeated measures mixed-methods study in a surgical intensive care unit. Wearable and environmental sensors captured work process data.

Evaluation of a Measurement System to Assess ICU Team Performance.

Objective: Measuring teamwork is essential in critical care, but limited observational measurement systems exist for this environment. The objective of this study was to evaluate the reliability and validity of a behavioral marker system for measuring teamwork in ICUs.

Design: Instances of teamwork were observed by two raters for three tasks: multidisciplinary rounds, nurse-to-nurse handoffs, and retrospective videos of medical students and instructors performing simulated codes.