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Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods 运用设计和人因法提高遗传学临床效率和能力
Maryam Attef, M. Cloutier, Meredith K. Gillespie, Chantal M. J. Trudel, K. Boycott
This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.
这项质量改进研究的重点是了解影响产前遗传学咨询师(GCs)在COVID-19大流行期间有效地为患者看病的能力的因素,以及使用人为因素和设计技术改善其工作流程的策略。对产前遗传学诊所的需求正在上升,这增加了GCs提高效率的压力。遗传咨询师可以通过减少在遗传咨询会诊前后花费的时间来改善他们的服务,从而增加他们看到的病人数量。我们仅限于某些方法来了解COVID-19大流行之前和期间工作流程的差异。这项研究包括文献综述、大流行前开展的工作流程研究的档案分析、利益攸关方会议和绘图、头脑风暴会议,以及在日记中记录任务时间和自然观察会议。进行了任务分析,以确定与空间设计、工艺和人工制品使用有关的影响效率的因素。虚拟和现场工作流程显示,在患者预约之前和/或之后,GCs至少花费了一半的时间在任务上。查看工作流程中潜在的低效率或瓶颈,形成了改进产前遗传学诊所GC工作流程的战略计划。通过此分析提出的改进仅限于支持在现有空间配置中工作的当前数量的医疗保健提供者。
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引用次数: 0
Incorporating Human Factors into a Healthcare System’s Covid-19 Communication Strategy 将人为因素纳入医疗保健系统的Covid-19沟通策略
R. Butler, Ann Katherine Hoobler, Lucy C. Stein, Erica S. Hoenig, Laura M. Lee, Kathryn M. Kellogg
The COVID-19 era has been an age of change for healthcare systems worldwide. At the beginning of the pandemic in particular, there was a huge need to rapidly communicate new and constantly changing information with critical safety implications. Previously successful communication strategies were not adequate for this unprecedented challenge. At MedStar Health, the Quality & Safety team led a unique partnership between human factors experts, clinical teams, and the communications department to develop a three-pronged strategy for effective communication during the pandemic. This strategy incorporated the following components: 1) Using human factors and usability concepts to distill complex clinical information into easy-to-understand infographics for frontline associates; 2) Creating regular, succinct messaging to distribute the information and provide frequent updates throughout the healthcare system; and 3) Designing and maintaining a usable webpage where associates could access up-to-date information relevant to their specialty at any time, on or off the hospital network. This strategy, which was dynamic and adapted to user feedback, was supported by associates as a streamlined method for communicating important information throughout the pandemic.
COVID-19时代是全球医疗保健系统的变革时代。特别是在大流行开始时,非常需要迅速传播具有关键安全影响的不断变化的新信息。以前成功的传播策略不足以应对这一前所未有的挑战。在MedStar Health,质量与安全团队在人为因素专家、临床团队和传播部门之间建立了独特的伙伴关系,制定了一项三管齐下的战略,以便在大流行期间进行有效沟通。该策略包括以下组成部分:1)利用人为因素和可用性概念将复杂的临床信息提炼成易于理解的信息图表,供一线员工使用;2)创建常规、简洁的消息传递,在整个医疗保健系统中分发信息并提供频繁更新;3)设计和维护一个可用的网页,让员工可以随时访问与其专业相关的最新信息,无论是否在医院网络上。这一战略是动态的,并根据用户反馈进行了调整,作为在整个大流行期间沟通重要信息的简化方法,得到了同事的支持。
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引用次数: 0
Development of a New Reusable and User-Centric General-Use Mask for Averting Respirator Supply Crisis in the Healthcare Sector 开发一种新的可重复使用和以用户为中心的通用口罩,以避免医疗保健部门的呼吸器供应危机
Aishwarya Uniyal, Pranav Madhav Kuber, A. Lobos, M. Magyar, E. Rashedi
Healthcare workforce implements general-use masks for low and/or moderate barrier protection in sterile environments. However, these masks are often unavailable in pandemic situations due to a strain on supply/demand logistics. In such cases, establishing development of respiratory protection within the organization may be beneficial. Our work presents one such novel method of designing customized masks by considering facial anthropometrics of the specific sample population. In fact, such a design may provide a more efficient fit with the users as compared to currently available masks, which are often designed for a much wider range of people. The protocol followed a fast-paced method of obtaining facial data (~2.8 mins/participant), and a data-driven approach for extracting design profiles. We have demonstrated the same through a pilot study, which involved recruiting a group of 7 participants with ethnic and gender variation. A total of 7 landmarks representing zygomatic process of the temporal, angle of mandible, zygomatic arch, nasal-maxillary region, and apex of nose, mid-lips and the chin were selected. Analysis included determining closest, mid-points, and farthest points for each landmark among the entire datasets. Results indicated that the landmarks: Apex of Nose, Midlips and Chin represented a straight-line path with a lateral shift of ~4.58 inches between the closest and farthest dimensions from the nose point, based on which the facepiece was designed. Meanwhile, geometric transformations consisting of several construction lines and bisectors were used along with obtained data from zygomatic arch, process of temporal, and angle of mandible landmarks to determine the contours of the straps for securing the mask. Our design addresses common issues in masks like discomfort around the ear, humidity, and reuse, by provision of a novel mounting method, fabric-based materials, and sleeve for replacement of filters, respectively. The proposed concept of the mask and the methods followed could also be applied in broader applications including manufacturing/construction and also daily-life activities besides hospital environments.
医疗保健工作人员在无菌环境中实施用于低和/或中等屏障保护的通用口罩。然而,由于供需物流紧张,在大流行情况下往往无法获得这些口罩。在这种情况下,在组织内建立呼吸保护的发展可能是有益的。我们的工作提出了一种通过考虑特定样本人口的面部人体测量学来设计定制面具的新方法。事实上,与目前可用的口罩相比,这种设计可能更有效地契合用户,因为目前的口罩通常是为更广泛的人群设计的。该方案采用快节奏的方法获取面部数据(约2.8分钟/参与者),并采用数据驱动的方法提取设计剖面。我们通过一项试点研究证明了这一点,该研究招募了7名种族和性别不同的参与者。选取颞骨颧突、下颌角、颧弓、鼻颌区、鼻尖、中唇、下巴共7个标志。分析包括确定整个数据集中每个地标的最近点、中点和最远点。结果表明:鼻尖、中唇和下巴的标志距鼻尖最近和最远的尺寸为一条直线,横向位移约为4.58英寸。同时,结合获得的颧弓、颞突、下颌骨地标角度等数据,利用多条构造线和等分线进行几何变换,确定固定口罩的绑带轮廓。我们的设计解决了口罩中常见的问题,如耳朵周围的不适、湿度和重复使用,分别提供了一种新的安装方法、基于织物的材料和用于更换过滤器的套筒。提出的口罩概念和方法也可以应用于更广泛的应用,包括制造/建筑和日常生活活动,除了医院环境。
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引用次数: 0
Using Simulated Handover to Assess Team-Based Competencies in a Virtual Environment 在虚拟环境中使用模拟交接来评估团队能力
Mozhdeh Sadighi, E. Lazzara, M. Michael, Jessica Hernandez, Chrissy Chan, I. H. Shields, Richard Preble, M. Phelps, S. Tannenbaum, P. Greilich
We utilized simulated patient scenarios in a virtual environment to improve students’ communication skills during handovers. To determine how students performed during the scenarios, we assessed several behaviors: structured communication, closed-loop communication, and asking clarification questions. Results revealed that the students’ performance was stronger in the first area (structure communication) and weaker in the second (closed-loop communication) and third (asking clarifying questions) areas.
我们利用虚拟环境中的模拟病人场景来提高学生在交接过程中的沟通技巧。为了确定学生在场景中的表现,我们评估了几种行为:结构化沟通、闭环沟通和提出澄清性问题。结果显示,学生在第一领域(结构沟通)表现较强,在第二领域(闭环沟通)和第三领域(提出澄清性问题)表现较弱。
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引用次数: 0
Exploring the Differences in Macrocognition between Experts and Non-CHD experts managing Congenital Heart Disease (CHD) 先天性心脏病专家与非冠心病专家宏观认知差异的探讨
A. Assadi, P. Laussen, P. Trbovich
Background and aims: Children with congenital heart disease (CHD) are at risk of deterioration in the face of common childhood illnesses, and their resuscitation and acute management is often best achieved with the guidance of CHD experts. Access to such expertise may be limited outside specialty heart centers and the fragility of these patients is cause for discomfort among many emergency medicine physicians. An understanding of the differences in macrocognition of these clinicians could shed light on some of the causes of discomfort and facilitate the development of a sociotechnological solution to this problem. Methods: Cardiac intensivists (CHD experts) and pediatric emergency medicine physicians (non-CHD experts) in a major academic cardiac center were interviewed using the critical decision method. Interview transcripts were coded deductively based on Klein’s macrocognitive framework and inductively to allow for new or modified characterization of dimensions. Results: While both CHD-experts and non-CHD experts relied on the macrocognitive functions of sensemaking, naturalistic decision making and detecting problems, the specific data and mental models used to understand the patients and course of therapy differed between CHD-experts and non-CHD experts. Conclusion: Characterization of differences between the macrocognitive processes of CHD experts and non-CHD experts can inform development of sociotechnological solutions to augment decision making pertaining to the acute management of pediatric CHD patients.
背景与目的:先天性心脏病(CHD)患儿在面对常见的儿童期疾病时存在病情恶化的风险,在冠心病专家的指导下,患儿的复苏和急性处理往往是最好的。在专业心脏中心之外,获得此类专业知识的机会可能有限,而这些患者的脆弱性是许多急诊医生感到不适的原因。了解这些临床医生在宏观认知上的差异,可以揭示不适的一些原因,并促进社会技术解决这一问题的发展。方法:采用关键决策法对某大型学术心脏中心的心脏病强化医师(冠心病专家)和儿科急诊科医师(非冠心病专家)进行访谈。访谈记录是基于克莱因的宏观认知框架和归纳编码演绎,以允许新的或修改的特征维度。结果:虽然冠心病专家和非冠心病专家都依赖于语义构建、自然决策和问题发现等宏观认知功能,但冠心病专家和非冠心病专家在理解患者和治疗过程中所使用的具体数据和心理模型存在差异。结论:对冠心病专家和非冠心病专家的宏观认知过程的差异进行表征,可以为制定社会技术解决方案提供信息,以增强与儿科冠心病患者急性管理相关的决策。
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引用次数: 0
Maternal Mortality Litigation Review 产妇死亡率诉讼审查
Sanjana Kothari, E. Patterson
Obstetrics and gynecology is considered one of the most litigious medical specialties; medical negligence and malpractice lawsuits are frequently filed to seek damages for improper medical care during childbirth. In fact, several studies have shown that a much greater percentage of maternal injury claims result in settlements or judgments as compared to other specialties. A considerable number of these claims can be linked to postpartum hemorrhage, or excessive bleeding following vaginal birth or cesarean delivery. This study aims to identify cases where postpartum hemorrhage contributed to maternal morbidity or mortality and led to a lawsuit. A review of litigation surrounding this topic was conducted using the Nexis Uni database from January 2011 to December 2020. Inclusion criteria consisted of maternal mortality cases due to postpartum hemorrhage, which discussed legal causes like medical negligence or obstetric violence. Evaluation of the litigation search results demonstrated various elements most associated with postpartum hemorrhage-related maternal injury litigation. Understanding challenges which arise most frequently in postnatal care settings will be useful in improving maternal health outcomes.
妇产科被认为是诉讼最多的医学专业之一;医疗疏忽和医疗事故诉讼经常被提起,以寻求对分娩期间不当医疗护理的损害赔偿。事实上,几项研究表明,与其他专业相比,孕产妇伤害索赔的和解或判决比例要高得多。相当多的这些索赔可能与产后出血有关,或阴道分娩或剖宫产后出血过多。本研究的目的是确定的情况下,产后出血导致产妇发病率或死亡率,并导致诉讼。2011年1月至2020年12月,使用Nexis Uni数据库对围绕这一主题的诉讼进行了审查。纳入标准包括因产后出血导致的产妇死亡案例,其中讨论了医疗疏忽或产科暴力等法律原因。对诉讼搜索结果的评估显示了与产后出血相关的孕产妇伤害诉讼最相关的各种因素。了解在产后护理环境中最常出现的挑战将有助于改善产妇保健结果。
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引用次数: 1
Considerations for translating medical devices under development from the clinic to the home: A case study in providing chronic wound care 将正在开发的医疗设备从诊所转化为家庭的考虑:提供慢性伤口护理的案例研究
E. Bass, Justine S. Sefcik, Elease J. McLaurin, R. Dimaria-Ghalili
A prototype medical device and protocol that work well in a clinic would not necessarily work reliably in the home setting. The goal of this work is to identify factors to consider when translating a device evaluated in a clinic for use by home caregivers providing chronic wound care for persons living with dementia. One must consider the current device, the associated bundle, the protocol and how they may need to be modified. Semi-structured interviews with the research assistants who have applied a prototype device were conducted to generate a list of known issues with the current clinical protocol in terms of ultrasound application The researchers performed a set of specified tasks by following the current device protocol and explaining any difficulties with useexecution. They embellished the descriptions with details about what had happened with actual patients in the clinic. Using thematic analysis, analysts identified themes and subthemes. Issues potentially relevant to translating medical devices to the home are discussed.
在诊所工作良好的原型医疗设备和协议不一定在家庭环境中可靠地工作。这项工作的目的是确定在翻译诊所评估的设备时需要考虑的因素,以便为痴呆症患者提供慢性伤口护理的家庭护理人员使用。必须考虑当前的设备、相关的包、协议以及它们可能需要如何修改。与应用原型设备的研究助理进行了半结构化访谈,以生成超声应用方面当前临床协议的已知问题列表。研究人员通过遵循当前设备协议并解释使用/执行中的任何困难来执行一组指定任务。他们在描述中详细描述了诊所里实际病人的情况。通过主题分析,分析人员确定了主题和副主题。讨论了可能与将医疗设备翻译到家庭相关的问题。
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引用次数: 0
Design and Development of a Prototype Heads-Up Display: Supporting Context-Aware, Semi-Automated, Hands-Free Medical Documentation 平视显示器原型的设计与开发:支持上下文感知、半自动、免提医疗文档
N. McGeorge, Susan Latiff, Christopher Muller1 Lucas Dong1, Ceara Chewning, Daniela Friedson-Trujillo, Stephanie Kane
Military and civilian medical personnel across all echelons of medical care play a critical role in evaluating, caring for, and treating casualties. Accurate medical documentation is critical to effective, coordinated care and positive patient outcomes. We describe our prototype, Context-Aware Procedure Support Tools and User Interfaces for Rapid and Effective Workflows (CAPTURE). Leveraging human factors and usercentered design methods, and advanced artificial intelligence and computer vision capabilities, CAPTURE was designed to enable Tactical Combat Causality Care (TCCC) providers to more efficiently and effectively input critical medical information through hands-free interaction techniques and semiautomated data capture methods. We designed and prototyped a heads-up display that incorporates: multimodal interfaces, including augmented reality-based methods for input and information display to support visual image capture and heads-up interaction; post-care documentation support (e.g., artifacts to support post-care review and documentation); context-aware active and passive data capture methods, specifically natural language interpretation using systemic functional grammars; and computer vision technologies for semi-automated data capture capabilities. During the course of this project we encountered challenges towards effective design which fall into three main categories: (1) challenges related to designing novel multimodal interfaces; (2) technical challenges related to software and hardware development to meet design needs; and (3) challenges as a result of domain characteristics and operational constraints. We discuss how we addressed some of these challenges and provide additional considerations necessary for future research regarding next generation technology design for medical documentation in the field.
各级医疗保健机构的军事和文职医务人员在评估、护理和治疗伤亡人员方面发挥着关键作用。准确的医疗记录对于有效、协调的护理和积极的患者预后至关重要。我们描述了我们的原型,上下文感知程序支持工具和快速有效工作流程(CAPTURE)的用户界面。利用人为因素和以用户为中心的设计方法,以及先进的人工智能和计算机视觉功能,CAPTURE旨在使战术战斗因果关系护理(TCCC)提供商能够通过免手动交互技术和半自动数据捕获方法更高效地输入关键医疗信息。我们设计并制作了一款平视显示器的原型,它包含:多模式界面,包括基于增强现实的输入和信息显示方法,以支持视觉图像捕获和平视交互;护理后文档支持(例如,支持护理后评审和文档的工件);上下文感知的主动和被动数据捕获方法,特别是使用系统功能语法的自然语言解释;计算机视觉技术用于半自动数据捕获能力。在这个项目的过程中,我们遇到了有效设计的挑战,主要分为三大类:(1)与设计新颖的多模式界面有关的挑战;(2)满足设计需要的软硬件开发方面的技术挑战;(3)领域特征和操作约束所带来的挑战。我们将讨论如何解决其中的一些挑战,并提供有关该领域医疗文档的下一代技术设计的未来研究所需的额外考虑。
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引用次数: 0
Household and population-level behavioural changes due to Covid-19 pandemic: A smart thermostat based comparative data analysis Covid-19大流行导致的家庭和人口层面的行为变化:基于智能恒温器的比较数据分析
Kirti Sundar Sahu, Arlene Oetomo, Niloofar Jalali, P. Morita
The World Health Organization declared the coronavirus outbreak as a pandemic on March 11, 2020. To inhibit the spread of COVID-19, governments around the globe, including Canada, have implemented physical distancing and lockdown measures, including a work-from-home policy. Canada in 2020 has developed a 24-Hour Movement Guideline for all ages laying guidance on the ideal amount of physical activity, sedentary behaviour, and sleep (PASS) for an individual in a day. The purpose of this study was to investigate changes on the household and population-level in lifestyle behaviours (PASS) and time spent indoors at the household level, following the implementation of physical distancing protocols and stay-at-home guidelines. For this study, we used 2019 and 2020 data from ecobee, a Canadian smart Wi-Fi thermostat company, through the Donate Your Data (DYD) program. Using motion sensors data, we quantified the amount of sleep by using the absence of movement, and similarly, increased sensor activation to show a longer duration of household occupancy. The key findings of this study were; during the COVID-19 pandemic, overall household-level activity increased significantly compared to pre-pandemic times, there was no significant difference between household-level behaviours between weekdays and weekends during the pandemic, average sleep duration has not changed, but the pattern of sleep behaviour significantly changed, specifically, bedtime and wake up time delayed, indoor time spent has been increased and outdoor time significantly reduced. Our data analysis shows the feasibility of using big data to monitor the impact of the COVID-19 pandemic on the household and population-level behaviours and patterns of change.
世界卫生组织于2020年3月11日宣布新冠肺炎疫情为大流行。为了遏制COVID-19的传播,包括加拿大在内的全球各国政府都实施了保持身体距离和封锁措施,包括在家工作政策。加拿大于2020年制定了适用于所有年龄段的24小时运动指南,为个人一天中的理想运动量、久坐行为和睡眠(PASS)提供指导。本研究的目的是调查在实施身体距离协议和居家指南后,家庭和人口层面生活方式行为(PASS)和家庭层面室内时间的变化。在这项研究中,我们使用了加拿大智能Wi-Fi恒温器公司ecobee通过“捐赠数据”(DYD)计划提供的2019年和2020年的数据。使用运动传感器数据,我们通过不运动来量化睡眠量,同样,增加传感器激活来显示更长的家庭占用时间。本研究的主要发现有:在2019冠状病毒病大流行期间,总体家庭活动与大流行前相比显著增加,家庭行为在大流行期间工作日和周末之间没有显著差异,平均睡眠时间没有改变,但睡眠行为模式发生了显著变化,具体而言,就寝时间和起床时间推迟,室内时间增加,室外时间显著减少。我们的数据分析表明,利用大数据监测COVID-19大流行对家庭和人口层面行为和变化模式的影响是可行的。
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引用次数: 1
Focusing the safety spotlight: How safety intelligence can inform systemic patient safety initiatives 聚焦安全焦点:安全情报如何为系统性患者安全举措提供信息
Anthony Soung Yee, Trevor Hall, Tracey A. Herlihey, J. Jeon, P. Trbovich, S. Gelmi
This panel discussion at the 2021 Human Factors and Ergonomics Society (HFES) Healthcare Symposium (HCS) touched upon several topics related to actioning safety intelligence to improve patient safety. The panel had representation from both Canada and England across a broad range of human factors expertise in healthcare: from the perspective of academic research, operational hospital work, patient safety incident investigation and national healthcare policy, and a nationwide healthcare liability insurer. The panelists began with defining safety intelligence and distinguishing between safety intelligence and safety wisdom. The panel provided an engaging and insightful discussion on several topics including data collection, analysis and actioning upon the insights gained. In addition, the panel discussed strategies for demonstrating value in improving patient safety, and emphasised the importance of aligning one’s work with existing initiatives in the organisation, as well as the importance of collaborating with various stakeholders across the system to affect meaningful change.
在2021年人类因素和人体工程学学会(hes)医疗保健研讨会(HCS)上的小组讨论涉及了与行动安全智能相关的几个主题,以提高患者安全。该小组有来自加拿大和英国的代表,涉及医疗保健领域广泛的人为因素专业知识:从学术研究、医院业务工作、患者安全事件调查和国家医疗保健政策的角度,以及一家全国性医疗保健责任保险公司。小组成员首先定义了安全智能,并区分了安全智能和安全智慧。小组就数据收集、分析和根据获得的见解采取行动等几个主题进行了引人入胜和富有洞察力的讨论。此外,小组讨论了在改善患者安全方面展示价值的策略,并强调了将自己的工作与组织现有举措保持一致的重要性,以及与整个系统的不同利益相关者合作以影响有意义的变革的重要性。
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引用次数: 0
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Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare. International Symposium of Human Factors and Ergonomics in Healthcare
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