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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最新文献

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Can Behavioural Science Be the Key to Unlocking Patient Adherence? Evidence-Led Development of an Engaging Digital Health Solution 行为科学能成为解锁患者依从性的关键吗?以证据为导向开发引人入胜的数字健康解决方案
Natasha Fosker, Alejandra Anderson, Laura Morton, Andrea M. Pisa
Patient self-management of illnesses place a greater responsibility on the patient, as they administer or track their own treatment. This amplifies the impact of adherence on outcomes – any missed or incorrect actions have the potential to reduce treatment efficacy. However, adherence is often lower than expected (e.g., around 50% for chronic conditions; WHO, 2003), making it a crucial aspect to address for effective patient centered management. This work created and evaluated a digital health concept (the Abily app) to increase patient adherence. Crux’s behavioural design methodology was used to integrate behavioural insights with design, developing the Abily app, which: (1) increased user attention, (2) increased task comprehension, and (3) reduced use problems. The results give promising evidence for using digital health solutions to raise adherence.
患者对疾病的自我管理赋予了患者更大的责任,因为他们管理或跟踪自己的治疗。这放大了依从性对结果的影响——任何遗漏或不正确的行动都有可能降低治疗效果。然而,依从性往往低于预期(例如,慢性疾病约为50%;世卫组织,2003年),使其成为解决以患者为中心的有效管理的关键方面。这项工作创造并评估了一个数字健康概念(Abily应用程序),以提高患者的依从性。Crux的行为设计方法被用于将行为洞察与设计相结合,开发了Abily应用程序,它:(1)提高了用户的注意力,(2)提高了任务理解能力,(3)减少了使用问题。研究结果为使用数字卫生解决方案提高依从性提供了有希望的证据。
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引用次数: 0
Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery 普通外科手术安全检查表的特点和使用背景
Jeunice Vianca Evangelista, Cherryl Li, Kimberley-Dale Ng, M. Fan, P. Trbovich
The Surgical Safety Checklist (SSCL) is a widely implemented intervention; however, limited studies have explored system factors that impact adherence to proper checklist completion. Using an audio-visual recording technology called the Operating Room Blackbox (ORBB), the goal of this study was to characterize the level of checklist completion and identify work system factors that impact the use of the SSCL in general laparoscopic surgery. Thirty-six cases captured by the ORBB in a hospital in Toronto, Ontario were reviewed using an SSCL audit tool to collect data on item-level adherence. The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model was applied to the observation notes from the ORBB recordings to identify work system factors influencing checklist use. On average, across all 36 cases, 8 of the 29 checklist items were completed (30.1%), with debriefing being completed most frequently of the 3 checklist sections. Of the 29 checklist items, commonly completed items were: patient concerns addressed, surgical counts complete, and procedure name, while items in the timeout section were completed the least. Notably, factors related to person (e.g., confirmation of patient information amongst surgical team) and tools and technology (e.g., use of checklist in combination with patient chart) were identified as facilitators to checklist use, while factors relating to tasks (e.g., redundancy of checklist items with existing workflow), tools and technology (e.g., some checklist items not applicable to some procedures), organization (e.g, timing of checklist items and absence of team member), and internal environment (e.g., music volume in the OR) were identified as potential barriers to checklist use. By understanding how system factors contribute to checklist use and item-level adherence, we can identify ways to improve the checklist to meet the needs of the OR team and enhance integration of the SSCL into existing workflows.
手术安全检查表(SSCL)是一项广泛实施的干预措施;然而,有限的研究已经探索了影响正确完成检查表的系统因素。使用一种称为手术室黑匣子(ORBB)的视听记录技术,本研究的目的是表征检查表完成程度,并确定影响SSCL在普通腹腔镜手术中使用的工作系统因素。使用SSCL审计工具对安大略省多伦多一家医院的36例病例进行审查,以收集项目级依从性的数据。患者安全系统工程计划(SEIPS) 2.0模型应用于来自ORBB记录的观察笔记,以确定影响检查表使用的工作系统因素。平均而言,在所有36个病例中,29个清单项目中有8个完成了(30.1%),在清单的3个部分中,汇报完成得最频繁。在29个检查表项目中,通常完成的项目是:患者关注的问题,手术计数完成和手术名称,而在超时部分完成的项目最少。值得注意的是,与人员相关的因素(例如,在手术团队中确认患者信息)和工具和技术(例如,将检查表与患者图表结合使用)被确定为使用检查表的促进因素,而与任务相关的因素(例如,现有工作流程中检查表项目的冗余),工具和技术(例如,一些检查表项目不适用于某些程序),组织(例如,检查表项目的时间安排和团队成员的缺席),和内部环境(例如手术室的音乐音量)被认为是使用检查表的潜在障碍。通过了解系统因素如何影响检查表的使用和项目级别的遵守,我们可以确定改进检查表的方法,以满足OR团队的需要,并增强SSCL与现有工作流程的集成。
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引用次数: 0
Developing Representations to Support Clinical Decision Making: Insights from Work Analysis 发展表征以支持临床决策:来自工作分析的见解
J. Flach
Principles of Work Domain Analysis (WDA) and Ecological Interface Design (EID) are illustrated using the example of a graphical interface designed to support clinical decision making with respect to cardiovascular health. Multiple iterations of the graphical interface will be presented that show the iterative analysis and design process and the logic of mapping meaningful dimensions into a representation that helps healthcare professionals to understand a complex biological system.
工作域分析(WDA)和生态界面设计(EID)的原则是通过一个图形界面的例子来说明的,该图形界面旨在支持心血管健康方面的临床决策。图形界面的多次迭代将展示迭代分析和设计过程,以及将有意义的维度映射到表示中的逻辑,帮助医疗保健专业人员理解复杂的生物系统。
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引用次数: 0
Using Journey Mapping to Visualize Patient Experiences for Quality Improvement Initiatives 使用旅程地图可视化患者体验,以提高质量
Kyle D. Maddox, A. Masalonis, Aneesa Motiwala, Kathleen Adams, Nakina Eugene, R. Speir
Journey mapping is a powerful user experience tool depicting customers’ interactions with an enterprise. This paper shows how the U.S. Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention (OMHSP), and the Veterans Health Administration (VHA) Office of Health Informatics (OHI) Human Factors Engineering Group, utilized journey mapping to discover patients’ psychotherapy experiences. The team conducted semi-structured interviews with Veterans, Caregivers, and Psychotherapy providers; and focus groups with OMHSP stakeholders, presenting successive iterations of four journey maps. The study used interview data to produce maps detailing representative depression patients’ mental health care experiences including: a patient suffering from coronavirus (COVID-19); a patient experiencing homelessness; a highly functional patient navigating implicit racial bias; and a patient resistant to therapy and his caregiver. The study identified areas of success and opportunities for improvement. Key findings included the importance of primary care in referrals; the desire to include family members in treatment; travel concerns in patients’ decisions about their care; the importance of viewing mental health care as part of a holistic view incorporating Veterans’ infrastructure (housing, employment, technology access, etc.); and varying levels of comfort toward technology and telehealth. The data also show opportunities to utilize health information technology to improve psychotherapy data collection and effect targeted quality improvement.
旅程映射是一种强大的用户体验工具,它描绘了客户与企业的交互。本文展示了美国退伍军人事务部(VA)心理健康和自杀预防办公室(OMHSP)和退伍军人健康管理局(VHA)健康信息办公室(OHI)人因工程小组如何利用旅程地图来发现患者的心理治疗经历。研究小组对退伍军人、护理人员和心理治疗提供者进行了半结构化访谈;以及与OMHSP利益相关者的焦点小组,展示四个旅程地图的连续迭代。该研究使用访谈数据制作了详细描述代表性抑郁症患者心理健康护理经历的地图,包括:患有冠状病毒(COVID-19)的患者;无家可归者:无家可归的病人;一个功能强大的病人在隐性种族偏见中导航;还有对治疗有抗药性的病人和他的看护人。该研究确定了成功的领域和改进的机会。主要发现包括初级保健在转诊中的重要性;将家庭成员纳入治疗的愿望;旅行对患者作出护理决定的影响;必须将精神保健视为纳入退伍军人基础设施(住房、就业、技术获取等)的整体观点的一部分;以及对科技和远程医疗的不同程度的适应。数据还显示了利用健康信息技术改善心理治疗数据收集和有针对性地提高质量的机会。
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引用次数: 1
Communicating Level of Certainty Associated with Human Factors Findings and Recommendations in Healthcare 医疗保健中与人为因素发现和建议相关的沟通确定性水平
Helen J. A. Fuller, Kathleen Adams
While there is a need for human factors engineering (HFE) in health systems design, the pace of operations in most healthcare systems often requires deviation from optimal HFE practices. We must provide sufficiently useful and usable findings to the design team and stakeholders to support project decisions while also tempering their expectations and properly calibrating their level of certainty around the findings and recommendations. As members of an HFE team in a series of projects related to the implementation of a new electronic health record (EHR) in a large healthcare system, we describe some early efforts with project teams and initial missteps that limited the effectiveness of HFE work. We also describe communication strategies we are piloting that appear to achieve better results in terms of project team engagement, stakeholder buy-in, and validity and utility of findings.
虽然在卫生系统设计中需要人因工程(HFE),但大多数卫生保健系统的操作速度往往需要偏离最佳的人因工程实践。我们必须为设计团队和涉众提供足够有用和可用的发现,以支持项目决策,同时也缓和他们的期望,并适当地校准他们围绕发现和建议的确定性水平。作为在大型医疗保健系统中实施新的电子健康记录(EHR)的一系列项目中的HFE团队成员,我们描述了项目团队的一些早期努力和最初的失误,这些失误限制了HFE工作的有效性。我们还描述了我们正在尝试的沟通策略,这些策略似乎在项目团队参与、涉众参与以及发现的有效性和实用性方面取得了更好的结果。
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引用次数: 0
Performance Based Evaluation of Cricothyroidotomy Simulators for Training 环甲软骨切开术训练模拟器的性能评价
J. Bliss, K. Etherton, Douglas Hodge, Jennifer Winner
The U.S. military has become increasingly reliant on simulators to train combat medical personnel. Human patient simulators that exist for training medical procedures represent task elements with varying degrees of fidelity. The goal of this research was to evaluate the functional fidelity of two commonly used simulators to train surgical cricothyroidotomy to experienced participants. Following a task analysis informed by experts, we collected performance training and test data from 14 experienced trainees. Each participant performed surgical cricothyroidotomies on porcine tracheas before and after five training sessions using one of two simulators. Comparisons of procedure completion times and errors showed development of task mastery by members of both training groups. Analyses of transfer of training from the final training session to the porcine posttest suggested that experienced participants were sensitive to differences between the training simulators and conditions of the posttest. Implications are presented as they relate to the use of simulation technologies for training cricothyroidotomy and the application of a standard method for fidelity assessment.
美国军方越来越依赖模拟器来训练战斗医疗人员。用于训练医疗程序的人类患者模拟器代表了具有不同保真度的任务元素。本研究的目的是评估两种常用的模拟器的功能保真度,以训练环甲环切开术的经验丰富的参与者。根据专家的任务分析,我们收集了14名经验丰富的学员的性能培训和测试数据。每个参与者在五次训练之前和之后使用两个模拟器中的一个对猪气管进行环甲状软骨切开术。程序完成时间和错误的比较显示了两个训练组成员对任务掌握的发展。从最后一次训练到猪后测的训练转移分析表明,有经验的参与者对训练模拟器和后测条件之间的差异很敏感。提示,因为他们涉及到使用模拟技术训练环甲状软骨切开术和保真度评估的标准方法的应用。
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引用次数: 0
In the Face of New Challenges; Effective Human Factors Engineering for Software as Medical Device Products 面对新的挑战;医疗器械产品软件的有效人因工程
Trine Groenborg
This paper tackles challenges facing human factors professionals when transitioning into working with Software as Medical Device products. Specifically, it outlines the challenges Novo Nordisk A/S has faced when it comes to applying human factors considerations when developing Software as Medical Device products and ensuring regulatory compliance. It showcases the efforts Novo Nordisk A/S has implemented to meet these challenges and conclude on the learnings Novo Nordisk A/S has had with the proposed solutions.
本文解决了人为因素专业人员在过渡到使用软件作为医疗器械产品时面临的挑战。具体来说,它概述了诺和诺德A/S在将软件开发为医疗器械产品并确保法规遵从性时应用人为因素考虑时所面临的挑战。它展示了诺和诺德A/S为应对这些挑战所做的努力,并总结了诺和诺德A/S从拟议的解决方案中获得的经验教训。
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引用次数: 0
Understanding Work-Related Injury Risk Among Rural Rehabilitation Clinicians 农村康复临床医师工伤风险的了解
Jiahui Ma, M. Fitzgerald, Sage Kittelman, B. McCrory
Background : Rehabilitation clinicians have a high risk of occupational injury. Work-related musculoskeletal disorders (WMSDs) are one of the most frequent injuries for rehabilitation clinicians due to repeated heavy lifting and other forceful tasks. The primary objective of this study was to identify factors that caused or contributed to WMSDs for clinicians specifically working in rehabilitation settings (e.g., acute care, inpatient rehabilitation, long-term care, outpatient therapy). Methods : An, in person, proctored questionnaire was conducted of physical therapists (PTs), occupational therapists (OTs) and therapy assistants working at a rural community hospital. Information on general workload, work-related pain or discomfort, patient handling, and clinical experience were gathered using both a scripted interview questionnaire and a semi-scripted post-interview discussion. The questionnaire was analyzed using both descriptive and inferential statistical methods to determine the 1-year prevalence of WMSDs and factors associated with WMSDs and use of safe patient handling techniques. Results : Respondents (n=27) included 18 PTs, 6 OTs and 3 therapy assistants. On average, rehabilitation clinicians spent over eight hours per day delivering “hands-on” care to patients. During a typical workday, therapists spent more than 20% performing heavy lifting, physically fatiguing tasks, or were in a static or awkward posture. Bending or twisting, repetitive tasks, and kneeling or squatting were each performed 30% or more of a typical workday, especially bending or twisting (38%). More than half (63%) suffered musculoskeletal pain/discomfort during the past year. Inadequate lifting devices were reported to be available in the working environment. A negative association was observed between the availability of multiple lifting devices and WMSDS (p-values<0.05). Less than a third of clinicians (31.5%) reported complete confidence to use mechanical lifting devices during rehabilitation activities. Conclusion : Rehabilitation clinicians are at higher risk for WMSDs due to patient handling tasks. More ongoing training must be provided to ensure clinicians have confidence to use the technologies available for rehabilitation tasks. However, additional research is still needed to understand the causal factors of WMSDs related to patient handling, particularly for rural care settings that lack access to technology and adequate staffing.
背景:康复临床医生有较高的职业伤害风险。与工作相关的肌肉骨骼疾病(WMSDs)是康复临床医生最常见的伤害之一,因为反复举重和其他有力的任务。本研究的主要目的是为专门从事康复工作的临床医生(如急症护理、住院康复、长期护理、门诊治疗)确定导致或促成wmsd的因素。方法:对在某农村社区医院工作的物理治疗师(PTs)、职业治疗师(OTs)和治疗助理进行问卷调查。一般工作量、与工作有关的疼痛或不适、患者处理和临床经验的信息通过脚本式访谈问卷和半脚本式访谈后讨论收集。使用描述性和推断性统计方法对问卷进行分析,以确定1年内WMSDs的患病率、与WMSDs相关的因素以及安全患者处理技术的使用情况。结果:受访者(n=27)包括18名pt, 6名ot和3名治疗助理。平均而言,康复临床医生每天花8个多小时为患者提供“动手”护理。在一个典型的工作日里,治疗师花了20%以上的时间做举重、体力疲劳的工作,或者保持静止或尴尬的姿势。在一个典型的工作日中,弯曲或扭转、重复性任务、跪或蹲各占30%或更多的时间,尤其是弯曲或扭转(38%)。在过去的一年里,超过一半(63%)的人患有肌肉骨骼疼痛/不适。据报告,在工作环境中没有足够的起重设备。多个起重装置的可用性与WMSDS呈负相关(p值<0.05)。不到三分之一的临床医生(31.5%)报告完全有信心在康复活动中使用机械升降装置。结论:康复临床医生因其对患者的处理任务而具有较高的wmsd风险。必须提供更多的持续培训,以确保临床医生有信心使用现有的技术进行康复任务。然而,仍然需要进一步的研究来了解与患者处理有关的WMSDs的因果因素,特别是对于缺乏技术和足够人员配备的农村护理机构。
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引用次数: 0
Patient Safety Challenges in the Pandemic: Applying Human Factors Principles to Embed Patient Safety and Experience at the Clinical Front Line 大流行中的患者安全挑战:应用人为因素原则将患者安全和经验融入临床一线
M. Chignell, Trevor Hall, Lili Liu, M. Kastner, F. Razak
The COVID-19 pandemic has amplified systemic gaps in patient safety, including social frailty for vulnerable populations such as older adults (Briguglio et al., 2020). Public health measures, such as prolonged and frequent lockdowns, restricted access to visitors and support networks and in extreme cases led to confinement within a single room, The negative impact of these restrictions has focused new attention on social frailty, which has hitherto been a somewhat neglected patient safety issue. Since social frailty is a multifaceted construct, it needs to be considered in a variety of settings and from a range of disciplinary perspectives. This practitioner-led panel consisting of an internist, a human factors engineer, an occupational therapist, and an implementation scientist, examines the impact of the pandemic on social interaction, and social frailty amongst older people in three different settings (hospital, long term care home, community). Through a set of case studies, the panelists provided applied experiences and perspectives on the impact of the pandemic on patient safety and on social frailty in particular. The panel covered theory, and real-world application of human factors principles. The question of how to design safety into the healthcare system were also explored. In this paper we review the problem of social frailty, list some brief case studies and discuss possible intervention strategies.
2019冠状病毒病大流行扩大了患者安全方面的系统性差距,包括老年人等弱势群体的社会脆弱性(Briguglio et al., 2020)。公共卫生措施,如长期和频繁的封锁,限制访客和支持网络的接触,在极端情况下导致禁闭在一个房间内。这些限制的负面影响使人们重新关注社会脆弱性,这迄今为止一直是一个有点被忽视的患者安全问题。由于社会脆弱性是一个多方面的结构,它需要在各种环境和从一系列学科的角度来考虑。这个由医生领导的小组由一名内科医生、一名人为因素工程师、一名职业治疗师和一名实施科学家组成,研究大流行对三种不同环境(医院、长期护理院、社区)中老年人的社会互动和社会脆弱性的影响。通过一系列案例研究,小组成员就大流行对患者安全和特别是对社会脆弱性的影响提供了应用经验和观点。小组讨论了人因原理的理论和实际应用。如何设计安全纳入医疗保健系统的问题也进行了探讨。在本文中,我们回顾了社会脆弱的问题,列举了一些简短的案例研究,并讨论了可能的干预策略。
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引用次数: 0
COVID-19 Vaccination Clinic Success: An Interdisciplinary Application of Simulation and Modeling COVID-19疫苗接种临床成功:模拟与建模的跨学科应用
Tammy R Toscos, Victor P. Cornet, Michelle Charles, Erica Cumbee, Charlotte Gabet, Ethel Massing, (Roger) Scott Stienecker
This paper shares a case study of a rapid cycle of process improvement, physical simulation, and simulation software development to stand up a mass COVID-19 vaccination site. The resulting standard work, clinic setup and simulation software tool were designed and implemented by an interdisciplinary team at a moderate size not-for-profit health system. This unique example of a simulation and modeling implementation led to a high throughput vaccination clinic with an outstanding patient experience.
本文分享了一个快速流程改进、物理模拟和模拟软件开发周期的案例研究,以建立一个大规模COVID-19疫苗接种站点。由此产生的标准工作、诊所设置和模拟软件工具由一个中等规模的非营利卫生系统的跨学科团队设计和实施。这个独特的模拟和建模实现的例子导致了高通量疫苗接种诊所与杰出的患者体验。
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引用次数: 2
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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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