Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review.

Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres-here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)-are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed.

Attention capture by own name decreases with speech compression.

Auditory stimuli that are relevant to a listener have the potential to capture focal attention even when unattended, the listener's own name being a particularly effective stimulus. We report two experiments to test the attention-capturing potential of the listener's own name in normal speech and time-compressed speech. In Experiment 1, 39 participants were tested with a visual word categorization task with uncompressed spoken names as background auditory distractors.

Exploring the Effect of Head-Worn Displays on Prehospital Teamwork Using Online Simulation: A Crossover Randomized Controlled Trial.

Introduction: Prehospital teamwork occurs in dynamic environments where paramedics work together using technologies to care for patients. Despite increasing interest in using head-worn displays (HWDs) to support prehospital workers, little is known about how HWDs affect teamwork.

Methods: We tested the effect of HWDs on the team processes and patient care of paramedic trainee teams in a laboratory study using an online prehospital simulation environment, SPECTRa.

Effects of Augmented Reality-Based Remote Mentoring on Task Performance and Communication: A Simulation Study in the Context of Emergency Medical Services.

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Effects of multitasking on interpreting a spearcon sequence display for monitoring multiple patients.

Spearcons are time-compressed speech phrases. When arranged in a sequence representing vital signs of multiple patients, spearcons may be more informative than conventional auditory alarms. However, multiple resource theory suggests that certain timeshared tasks might interfere with listeners' ability to understand spearcons.

Interruptions in healthcare: Modeling dynamic processes and effects at a team level.

Interruptions are associated with increases in medical errors amongst healthcare professionals, yet interventions to reduce interruptions have not been widely successful. While interruptions can be problematic for the interruptee, they may be necessary for the interrupter to maintain patient safety. To understand the emergent effects of interruptions within a dynamic environment, we develop a computational model that describes how nurses make decisions about interruptions and the effects those decisions have at a team level.

Evaluating enhanced pulse oximetry auditory displays for neonatal oxygen targeting: A randomized laboratory trial with clinicians and non-clinicians.

Standard pulse oximeter auditory tones do not clearly indicate departures from the target range of oxygen saturation (SpO) of 90%-95% in preterm neonates. We tested whether acoustically enhanced tones would improve participants' ability to identify SpO range. Twenty-one clinicians and 23 non-clinicians used (1) standard pulse oximetry variable-pitch tones plus alarms; (2) beacon-enhanced tones without alarms in which reference tones were inserted before standard pulse tones when SpO was outside target range; and (3) tremolo-enhanced tones without alarms in which pulse tones were modified with tremolo when SpO was outside target range.

Enhanced Neonatal Pulse Oximetry Sounds for the First Minutes of Life: A Laboratory Trial.

Objective: Auditory enhancements to the pulse oximetry tone may help clinicians detect deviations from target ranges for oxygen saturation (SpO) and heart rate (HR).

Background: Clinical guidelines recommend target ranges for SpO and HR during neonatal resuscitation in the first 10 minutes after birth. The pulse oximeter currently maps HR to tone rate, and SpO to tone pitch.

Auditory Sequences Presented With Spearcons Support Better Multiple Patient Monitoring Than Single-Patient Alarms: A Preclinical Simulation.

Objective: A study of auditory displays for simulated patient monitoring compared the effectiveness of two sound categories (alarm sounds indicating general risk categories from international alarm standard IEC 60601-1-8 event-specific sounds according to the type of nursing unit) and two configurations (single-patient alarms multi-patient sequences).

Background: Fieldwork in speciality-focused high dependency units (HDU) indicated that auditory alarms are ambiguous and do not identify which patient has a problem. We tested whether participants perform better using auditory displays that identify the relevant patient and problem.

Similarity of expert clinicians' rank order of differential diagnoses in a newborn resuscitation context.

Background: We tested principles that could lead to a future cognitive aid that offers an interpretation of the newborn's physiological state during resuscitation after birth. Using concordance among experts' interpretations of newborn vital sign patterns as an approximation for an algorithm that could provide an interpretation of the newborn's state, we explored the reliability and generalisability of experts' interpretations.

Methods: Twelve neonatal experts viewed eight pairs of graphical trajectories showing newborns' heart rate and oxygen saturation records supplemented with differential diagnoses elicited previously from other experts.

Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones.

Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface.

Attention to Changes on a Head-Worn Display: Two Preclinical Studies with Healthcare Scenarios.

Objective: In two experiments, we examined how quickly different visual alerts on a head-worn display (HWD) would capture participants' attention to a matrix of patient vital sign values, while multitasking.

Background: An HWD could help clinicians monitor multiple patients, regardless of where the clinician is located. We sought effective ways for HWDs to alert multitasking wearers to important events.

SPECTRa: An Online Tool for Simulating Prehospital Patient Care.

Objectives: To (1) develop a simulation software environment to conduct prehospital research during the COVID-19 pandemic on paramedics' teamwork and use of mobile computing devices, and (2) establish its feasibility for use as a research and training tool.

Background: Simulation-based research and training for prehospital environments has typically used live simulation, with highly realistic equipment and technology-enhanced manikins. However, such simulations are expensive, difficult to replicate, and require facilitators and participants to be at the same location.

Need for a new paradigm in the design of alarms for patient monitors and medical devices.

Modern computerised medical devices emit large numbers of tone-based alerts and alarms. Notifications that comprise auditory icons or natural human speech substantially increase the psychological salience of alerts and alarms and may allow a larger set of notifications to be used, as they do not require memorisation of arbitrary sounds.

A review of the effects of head-worn displays on teamwork for emergency response.

Head-Worn Displays (HWD) can potentially support the mobile work of emergency responders, but it remains unclear whether teamwork is affected when emergency responders use HWDs. We reviewed studies that examined HWDs in emergency response contexts to evaluate the impact of HWDs on team performance and on team processes of situation awareness, communication, and coordination. Sixteen studies were identified through manual and systematic literature searches.

Examining the efficacy of vibrotactile displays for monitoring patient vital signs: Six laboratory studies of change detection and state identification.

Healthcare workers often monitor patients while moving between different locations and tasks, and away from conventional monitoring displays. Vibrotactile displays can provide patient information in vibrotactile patterns that are felt regardless of the worker's location. We examined how effectively participants could identify changes in vibrotactile representations of patient heart rate (HR) and oxygen saturation (SpO₂).

Concordance of expert clinicians' interpretations of the newborn's true physiological state.

Background: Many physiological aspects of the neonatal transition after birth are unobservable because relevant sensors do not yet exist, compromising clinicians' understanding of a neonate's physiological status. Given that a neonate's true physiological state is currently unavailable, we explored the feasibility of using clinicians' degree of concordance as an approximation of the true physiological state.

Methods: Two phases of structured interviews were conducted.

Nurses' use of auditory alarms and alerts in high dependency units: A field study.

A fieldwork study conducted in six units of a major metropolitan Australian hospital revealed that nurses' attitudes towards alarms are influenced by each unit's physical layout and caseload. Additionally, nurses relied heavily on both non-actionable and actionable alarms to maintain their awareness of the status of their patients' wellbeing, and used auditory alarms beyond the scope of their intended design. Results suggest that before reducing or removing auditory alarms from the clinical environment to improve patient safety, it is important to understand how nurses in different clinical contexts use current alarm systems to extract meaningful information.

The Use of Head-Worn Displays for Vital Sign Monitoring in Critical and Acute Care: Systematic Review.

Background: Continuous monitoring of patient vital signs may improve patient outcomes. Head-worn displays (HWDs) can provide hands-free access to continuous vital sign information of patients in critical and acute care contexts and thus may reduce instances of unrecognized patient deterioration.

Objective: The purpose of the study is to conduct a systematic review of the literature to evaluate clinical, surrogate, and process outcomes when clinicians use HWDs for continuous patient vital sign monitoring.

Spearcon compression levels influence the gap in comprehension between untrained and trained listeners.

Auditory alarms in hospitals are ambiguous and do not provide enough information to support doctors and nurses' awareness of patient events. A potential alternative is the use of short segments of time-compressed speech, or However, sometimes it might be desirable for patients to understand spearcons and sometimes not. We used reverse hierarchy theory to hypothesize that there will be a degree of compression where spearcons are intelligible for trained listeners but not for untrained listeners.

Evaluation of an enhanced pulse oximeter auditory display: a simulaion study.

Background: We compared anaesthetists' ability to identify haemoglobin oxygen saturation (SpO) levels using two auditory displays: one based on a standard pulse oximeter display (varying pitch plus alarm) and the other enhanced with additional sound properties (varying pitch plus tremolo and acoustic brightness) to differentiate SpO ranges.

Methods: In a counter-balanced crossover study in a simulator, 20 experienced anaesthetists supervised a junior colleague (an actor) managing two airway surgery scenarios: once while using the enhanced auditory display and once while using a standard auditory display. Participants were distracted with other tasks such as paperwork and workplace interruptions, but were required to identify when SpO transitioned between pre-set ranges (target, low, critical) and when other vital signs transitioned out of a target range.

Defining information needs in neonatal resuscitation with work domain analysis.

Objective: To gain a deeper understanding of the information requirements of clinicians conducting neonatal resuscitation in the first 10 min after birth.

Background: During the resuscitation of a newborn infant in the first minutes after birth, clinicians must monitor crucial physiological adjustments that are relatively unobservable, unpredictable, and highly variable. Clinicians' access to information regarding the physiological status of the infant is also crucial to determining which interventions are most appropriate.

From bartending interruptions to medication delivery interruptions: Managing the risks of a high-fidelity simulation study with pilot research.

In this paper we describe the risks of complex applied research, especially in work domains where professional practitioners are scarce. For such research, careful preparation and piloting is needed, especially when estimating sample size is required for a full study. However, such pilot work may reduce the potential sample size for the full study.

Developing safe devices for neonatal care.

Currently, the majority of medical devices are designed for adults; some are then miniaturized for use in neonates. This process neglects population-specific testing that would ensure that the medical devices used for neonates are actually safe and effective for that group. Incorporating human-centered design principles and utilizing methods to evaluate devices that include simulation and clinical testing can improve the safety of devices used in caring for neonates.