An image dataset for surveillance of personal protective equipment adherence in healthcare.

Proper personal protective equipment (PPE) use is critical to prevent disease transmission to healthcare providers, especially those treating patients with a high infection risk. To address the challenge of monitoring PPE usage in healthcare, computer vision has been evaluated for tracking adherence. Existing datasets for this purpose, however, lack a diversity of PPE and nonadherence classes, represent single not multiple providers, and do not depict dynamic provider movement during patient care.

Human intention recognition for trauma resuscitation: An interpretable deep learning approach for medical process data.

Objective: Trauma resuscitation is the initial evaluation and management of injured patients in the emergency department. This time-critical process requires the simultaneous pursuit of multiple resuscitation goals. Recognizing whether the required goal is being pursued can reduce errors in goal-related task performance and improve patient outcomes.

Comparative analysis of personal protective equipment nonadherence detection: computer vision versus human observers.

Objectives: Human monitoring of personal protective equipment (PPE) adherence among healthcare providers has several limitations, including the need for additional personnel during staff shortages and decreased vigilance during prolonged tasks. To address these challenges, we developed an automated computer vision system for monitoring PPE adherence in healthcare settings. We assessed the system performance against human observers detecting nonadherence in a video surveillance experiment.

Factors associated with correction of personal protective equipment nonadherence in a multidisciplinary emergency department setting: A retrospective video review.

Background: Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence.

Methods: We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction.

Analysis of Task Attributes Associated with Crisis Checklist Compliance in Pediatric Trauma Resuscitation.

Although checklists can improve overall team performance during medical crises, non-compliant checklist use poses risks to patient safety. We examined how task attributes affected checklist compliance by studying the use of a digital checklist during trauma resuscitation. We first determined task attributes and checklist compliance behaviors for 3,131 resuscitation tasks.

Real-time Context-Aware Multimodal Network for Activity and Activity-Stage Recognition from Team Communication in Dynamic Clinical Settings.

In clinical settings, most automatic recognition systems use visual or sensory data to recognize activities. These systems cannot recognize activities that rely on verbal assessment, lack visual cues, or do not use medical devices. We examined speech-based activity and activity-stage recognition in a clinical domain, making the following contributions.

Transitioning Cognitive Aids into Decision Support Platforms: Requirements and Design Guidelines.

Digital cognitive aids have the potential to serve as clinical decision support platforms, triggering alerts about process delays and recommending interventions. In this mixed-methods study, we examined how a digital checklist for pediatric trauma resuscitation could trigger decision support alerts and recommendations. We identified two criteria that cognitive aids must satisfy to support these alerts: (1) context information must be entered in a timely, accurate, and standardized manner, and (2) task status must be accurately documented.

An Analysis of Speech during Life Saving Interventions to Inform the Design of a Computerized System for Delay Detection.

We describe an analysis of speech during time-critical, team-based medical work and its potential to indicate process delays. We analyzed speech intention and sentence types during 39 trauma resuscitations with delays in one of three major lifesaving interventions: intravenous/intraosseous (IV/IO) line insertion, cardiopulmonary and resuscitation (CPR), and intubation. We found a significant difference in patterns of speech during delays vs.

Discovering interpretable medical process models: A case study in trauma resuscitation.

Understanding the actual work (i.e., "work-as-done") rather than theorized work (i.

Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation.

Introduction: Intravenous access is required for resuscitation of injured patients but may be delayed in children because of challenges associated with peripheral intravenous (PIV) catheter placement. Early identification of factors predisposing patients to difficult PIV placement can assist in deciding strategies for timely intravenous access.

Methods: We conducted a retrospective, video-based review of injured children and adolescents treated between April 2018 and May 2019.

Designing Interactive Alerts to Improve Recognition of Critical Events in Medical Emergencies.

Vital sign values during medical emergencies can help clinicians recognize and treat patients with life-threatening injuries. Identifying abnormal vital signs, however, is frequently delayed and the values may not be documented at all. In this mixed-methods study, we designed and evaluated a two-phased visual alert approach for a digital checklist in trauma resuscitation that informs users about undocumented vital signs.

User Needs and Challenges in Information Sharing between Pre-Hospital and Hospital Emergency Care Providers.

Effective communication between pre-hospital and hospital providers is a critical first step towards ensuring efficient patient care. Despite many efforts in improving the communication process, inefficiencies persist. It is critical to understand user needs, work practices, and existing barriers to inform technology design for supporting pre-hospital communication.

Transitioning to Remote User-Centered Design Activities in the Emergency Medical Field During a Pandemic.

During the COVID-19 pandemic, we had to transition our user-centered research and design activities in the emergency medical domain of trauma resuscitation from in-person settings to online environments. This transition required that we replicate the in-person interactions remotely while maintaining the critical social connection and the exchange of ideas with medical providers. In this paper, we describe how we designed and conducted four user-centered design activities from our homes: participatory design workshops, near-live simulation sessions, usability evaluation sessions, and interviews and design walkthroughs.

Exploring the Design of Streaming Data Interfaces for Emergency Medical Contexts.

In this late-breaking work, we describe the design of an interface for displaying streaming vital sign data on a digital checklist used in the emergency medical setting of pediatric trauma resuscitation. We used feedback from interviews and participatory design workshops with clinicians to develop two prototypes of the streaming vital sign interface. We evaluated these prototypes in design-walkthroughs, finding that clinicians preferred the design displaying trend graphs for all four vital signs at once.

Personal Protective Equipment Adherence of Pediatric Resuscitation Team Members During the COVID-19 Pandemic.

Study Objective: During the COVID-19 pandemic, health care workers have had the highest risk of infection among essential workers. Although personal protective equipment (PPE) use is associated with lower infection rates, appropriate use of PPE has been variable among health care workers, even in settings with COVID-19 patients. We aimed to evaluate the patterns of PPE adherence during emergency department resuscitations that included aerosol-generating procedures.

Metrics of shock in pediatric trauma patients: A systematic search and review.

Introduction: Shock-index (SI) and systolic blood pressure (SBP) are metrics for identifying children and adults with hemodynamic instability following injury. The purpose of this systematic review was to assess the quality of these metrics as predictors of outcomes following pediatric injury.

Materials And Methods: We conducted a literature search in Pubmed, SCOPUS, and CINAHL to identify studies describing the association between shock metrics on the morbidity and mortality of injured children and adolescents.

Association of Ventilation during Initial Trauma Resuscitation for Traumatic Brain Injury and Post-Traumatic Outcomes: A Systematic Review.

Objectives: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period.

Assessment of Non-Routine Events and Significant Physiological Disturbances during Emergency Department Evaluation after Pediatric Head Trauma.

Outcomes following pediatric traumatic brain injury (TBI) are dependent on initial injury severity and prevention of secondary injury. Hypoxia, hypotension, and hyperventilation following TBI are associated with increased mortality. The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances.

Classification strategies for non-routine events occurring in high-risk patient care settings: A scoping review.

Introduction: Non-routine events (NREs) are atypical or unusual occurrences in a pre-defined process. Although some NREs in high-risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will facilitate the comparison of results between studies.

Assessment of Nonroutine Events During Intubation After Pediatric Trauma.

Background: Intubation in the early postinjury phase can be a high-risk procedure associated with an increased risk of mortality when delayed. Nonroutine events (NREs) are workflow disruptions that can be latent safety threats in high-risk settings and may contribute to adverse outcomes.

Materials And Methods: We reviewed videos of intubations of injured children (age<17 y old) in the emergency department occurring between 2014 and 2018 to identify NREs occurring between the decision to intubate and successful intubation ("critical window").

Understanding Digital Checklist Use Through Team Communication.

Introducing technology support in a complex, team-based work setting requires a study of teamwork effects on technology use. In this paper, we present our initial analysis of team communications in a trauma resuscitation setting, where we deployed a digital checklist to support trauma team leaders in guiding patient care. By analyzing speech transcripts, checklist interaction logs, and videos of 15 resuscitations, we identified several tensions that arose from the use of a checklist in a team-based process with multi-step tasks.

Checklist Design Reconsidered: Understanding Checklist Compliance and Timing of Interactions.

We examine the association between user interactions with a checklist and task performance in a time-critical medical setting. By comparing 98 logs from a digital checklist for trauma resuscitation with activity logs generated by video review, we identified three non-compliant checklist use behaviors: failure to check items for completed tasks, falsely checking items when tasks were not performed, and inaccurately checking items for incomplete tasks. Using video review, we found that user perceptions of task completion were often misaligned with clinical practices that guided activity coding, thereby contributing to non-compliant check-offs.

Comparing the Effects of Paper and Digital Checklists on Team Performance in Time-Critical Work.

This mixed-methods study examines the effects of a tablet-based checklist system on team performance during a dynamic and safety-critical process of trauma resuscitation. We compared team performance from 47 resuscitations that used a paper checklist to that from 47 cases with a digital checklist to determine if digitizing a checklist led to improvements in task completion rates and in how fast the tasks were initiated for 18 most critical assessment and treatment tasks. We also compared if the checklist compliance increased with the digital design.

Association Between Prearrival Notification Time and Advanced Trauma Life Support Protocol Adherence.

Background: Prearrival notification of injured patients facilitates preparation of personnel, equipment, and other resources needed for trauma evaluation and treatment. Our purpose was to determine the impact of prearrival notification time on adherence to Advanced Trauma Life Support (ATLS) protocols.

Materials And Methods: Pediatric trauma activations of admitted patients were analyzed by video review to determine activities performed before and after patient arrival.