Between choice and chance: the role of human factors in acute care equipment decisions.

Objectives: We report on a human factors evaluation project at a major urban teaching hospital that was intended to use human factors methods to assist the selection of a new infusion device among 4 commercially available models.

Methods: The project provided an expert evaluation of the pumps, collected data on programming each pump by a sample of practitioners, tabulated recent adverse event reports in the US Food and Drug Administration Manufacturer and User Device Experience database, and observed actual use in intensive care and hematology/oncology units.

Results: Programming by clinicians showed no correlation between clinical experience and ability to program any of the pumps under consideration. Field observations reflected diverse use patterns across services that required ease of use pumps did not offer. Upon review of a final candidate pump, purchasing preferences superceded clinical considerations.

Conclusions: Equipment and systems that are intended for use by clinicians must necessarily reflect an understanding of actual clinical practice to be well suited for use at the sharp (operator) end. However, purchase decisions for medical equipment including infusion devices are typically made by hospital staff members who are experienced in administrative and clinical matters but have no expertise in the evaluation of complex equipment. This project demonstrates how collaboration by human factors and clinical professionals can inform equipment decisions and assist clinician performance to improve patient safety. It also reveals how technical decisions that directly influence anesthesia staff performance and patient safety are subject to organizational factors such as social and political pressure.