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Current Treatment Options in Pediatrics

Erschienen in:

01.06.2019 | Patient Safety (M Scanlon, Section Editor)

Human Factors Engineering: Status, Interventions, Future Directions in Pediatrics

verfasst von: Siddarth Ponnala, MS, A. Joy Rivera, PhD

Erschienen in: Current Treatment Options in Pediatrics | Ausgabe 2/2019

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Abstract

Purpose of Review

Human Factors Engineering (HFE) has had much success in research initiatives to identify socio-technical system barriers to improve patient and employee safety and healthcare quality. However, there have only been a few applications of HFE, in which research is translated into practice, and has been implemented in an organization. This paper presents a systematic review of HFE interventions that have been implemented to improve healthcare quality and patient safety, specific to the pediatric population. This paper also discusses the current status of HFE in healthcare and how the science of HFE can be further applied to improve safety in healthcare delivery processes.

Recent Findings

In the last few years, HFE has been applied in many different areas in healthcare. These areas include EHR design, imaging, medication management, patient experience, and care transitions. The interventions include a combination of cognitive, physical, and macroergonomics principles to improve healthcare delivery for pediatric populations.

Summary

This systematic review identifies 28 peer-reviewed articles that have applied HFE in design, development, and implementation of an intervention to improve safety and/or quality for the pediatric population. The articles employ quantitative, qualitative, or mixed methods to assess the effectiveness, acceptability, and sustainability of the intervention.

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IEA. Definition and domains of ergonomics. Obtained from IEA: http://www.iea.cc/whats/index.html. 2015. Accessed 31 Oct 2018.

Sanders MS, McCormick EJ. Human factors in engineering. Control Des. 1993;9(10):11.

Wickens CD, Gordon SE, Liu Y, Lee J. An introduction to human factors engineering. 1998.

Berg Rice VJ, Brickman D, Lueder R, Smith-Jackson T, Vredenburgh A, Zackowitz I. Designing for children: what do human factors professionals need to know? Proceedings of the Human Factors and Ergonomics Society Annual Meeting. Los Angeles, CA: SAGE Publications Sage CA; 2015.

10.

Karsh B. Beyond usability: designing effective technology implementation systems to promote patient safety. BMJ Qual Saf. 2004;13(5):388–94.CrossRef

11.

Maguire M. Context of use within usability activities. Int J of Hum Comp Stud. 2001.

12.

Kleiner BM. Macroergonomics: analysis and design of work systems. Appl Ergon. 2006;37(1):81–9.CrossRefPubMed

13.

Larsen E. Macroergonomics to understand factors impacting patient care during electronic health record downtime. Doctoral dissertation. Virginia Tech; 2018.

14.

• de Carvalho, Paulo VR, Righi AW, Huber GJ, Lemos CF, Jatoba A, Gomes JO. Reflections on work as done (WAD) and work as imagined (WAI) in an emergency response organization: a study on firefighters training exercises. Appl Ergon. 2018;68:28–41. This paper highlights the meaning of work as done vs. work as imagined and puts it in context of a Human factors Intervention. It provides, researchers and clinicians who do not have sufficient background on the HFE, an understanding how this concept has progressed and can be applied.CrossRefPubMed

15.

•• Carayon P, Kianfar S, Li Y, Xie A, Alyousef B, Wooldridge A. A systematic review of mixed methods research on human factors and ergonomics in health care. Appl Ergon. 2015;51:291–321. This study provides a systematic review of mixed methods research efforts in HFE. It shows all the different areas of healthcare that have been successful in implementing mixed methods, and the results of each of these efforts.CrossRefPubMedPubMedCentral

16.

Carayon P, Hundt AS, Karsh B, Gurses AP, Alvarado C, Smith M, et al. Work system design for patient safety: the SEIPS model. BMJ Qual Saf. 2006;15(suppl 1):i50–i8.CrossRef

17.

Carayon P, Xie A, Kianfar S. Human factors and ergonomics as a patient safety practice. BMJ Qual Saf. 2014;23(3):196–205. https://doi.org/10.1136/bmjqs-2013-001812.

18.

Chan AJ, Islam MK, Rosewall T, Jaffray DA, Easty AC, Cafazzo JA. The use of human factors methods to identify and mitigate safety issues in radiation therapy. Radiother Oncol. 2010;97(3):596–600.CrossRefPubMed

19.

Bonnabry P, Despont-Gros C, Grauser D, Casez P, Despond M, Pugin D, et al. A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety. J Am Med Inform Assoc. 2008;15(4):453–60.CrossRefPubMedPubMedCentral

20.

•• Ratwani RM, Savage E, Will A, Fong A, Karavite D, Muthu N, et al. Identifying electronic health record usability and safety challenges in pediatric settings. Health affairs. 2018;37(11):1752–9. This study provides valuable insight on the patient safety issues that have been identified with the integration of EHR in to clinical processes. It provides many areas where cognitive and macroergonomics can be applied to overcome usability barriers.CrossRefPubMed

21.

Health UDo, Services H. Agency for healthcare research and quality. National Healthcare Quality Report; 2010. p. 2635–45.

22.

Scanlon MC, Karsh B-T, Densmore EM. Human factors engineering and patient safety. Pediatr Clin N Am. 2006;53(6):1105–19. https://doi.org/10.1016/j.pcl.2006.09.012.CrossRef

23.

Rowe C, Koren T, Koren G. Errors by paediatric residents in calculating drug doses. Arch Dis Child. 1998;79(1):56–8.CrossRefPubMedPubMedCentral

24.

Bauer DT, Guerlain S, Brown PJ. The design and evaluation of a graphical display for laboratory data. J Am Med Inform Assoc. 2010;17(4):416–24. https://doi.org/10.1136/jamia.2009.000505.CrossRefPubMedPubMedCentral

25.

Browd SR, Zauberman J, Karandikar M, Ojemann JG, Avellino AM, Ellenbogen RG. A new fiber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering. J Neurosurg Pediatr. 2009;4(3):280–4. https://doi.org/10.3171/2009.4.PEDS08349.CrossRefPubMed

26.

• Carayon P, Wetterneck TB, Alyousef B, Brown RL, Cartmill RS, McGuire K, et al. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. International Journal of Medical Informatics. 2015;84(8):578–94. https://doi.org/10.1016/j.ijmedinf.2015.04.002. Carayon is known for being a leading expert in the field of HFE and patient safety. This study by her team presents an excellent example on HFE methodology and analysis that can be widely applied to resolve many other challenges in healthcare.

27.

Catchpole KR, Dale TJ, Hirst DG, Smith JP, Giddings TA. A multicenter trial of aviation-style training for surgical teams. Journal of Patient Safety. 2010;6(3):180–6. https://doi.org/10.1097/PTS.0b013e3181f100ea.CrossRefPubMed

28.

Clebone A, Burian BK, Polaner DM. A time-out checklist for pediatric regional anesthetics. Reg Anesth Pain Med. 2017;42(1):105–8. https://doi.org/10.1097/AAP.0000000000000509.CrossRefPubMed

29.

Colligan L, Guerlain S, Steck SE, Hoke TR. Designing for distractions: a human factors approach to decreasing interruptions at a centralised medication station. BMJ Qual Saf. 2012;21(11):939–47. https://doi.org/10.1136/bmjqs-2011-000289.CrossRefPubMed

30.

de Korne DF, van Wijngaarden JD, van Rooij J, Wauben LS, Hiddema UF, Klazinga NS. Safety by design: effects of operating room floor marking on the position of surgical devices to promote clean air flow compliance and minimise infection risks. BMJ Qual Saf. 2012;21(9):746–52. https://doi.org/10.1136/bmjqs-2011-000138.CrossRefPubMed

31.

de Vries EN, Hollmann MW, Smorenburg SM, Gouma DJ, Boermeester MA. Development and validation of the SURgical PAtient Safety System (SURPASS) checklist. Qual Saf Health Care. 2009;18(2):121–6. https://doi.org/10.1136/qshc.2008.027524.CrossRefPubMed

32.

Erfanian K, Luks FI, Kurkchubasche AG, Wesselhoeft CW Jr, Tracy TF Jr. In-line image projection accelerates task performance in laparoscopic appendectomy. J Pediatr Surg. 2003;38(7):1059–62. https://doi.org/10.1016/S0022-3468(03)00192-1.CrossRefPubMed

33.

Frykman PK, Freedman AL, Kane TD, Cheng Z, Petrosyan M, Catchpole K. A study of VITOM in pediatric surgery and urology: evaluation of technology acceptance and usability by operating team and surgeon musculoskeletal discomfort. J Laparoendosc Adv Surg Tech. 2017;27(2):191–6. https://doi.org/10.1089/lap.2016.0225.CrossRef

34.

Hohenhaus SM, Cadwell SM, Stone-Griffith S, Sears-Russell N, Baxter T, Hicks W, et al. Assessment of emergency nursing practice during critical pediatric medication administration in a simulated resuscitation using the “color coding kids hospital system” a multisite trial. Adv Emerg Nurs J. 2008;30(3):233–41. https://doi.org/10.1097/01.TME.0000334375.44529.09.

35.

Holden RJ, Brown RL, Alper SJ, Scanlon MC, Patel NR, Karsh BT. That’s nice, but what does IT do? Evaluating the impact of bar coded medication administration by measuring changes in the process of care. Int J Ind Ergon. 2011;41(4):370–9. https://doi.org/10.1016/j.ergon.2011.02.007.CrossRefPubMedPubMedCentral

36.

• Holden RJ, Brown RL, Scanlon MC, Rivera AJ, Karsh BT. Micro- and macroergonomic changes in mental workload and medication safety following the implementation of new health IT. Int J Ind Ergon. 2015;49:131–43. https://doi.org/10.1016/j.ergon.2014.04.003. Holden and team illustrate that socio-technical systems context is extremely important when implementing HFE interventions. Their wholistic analysis of macroergonomics and micro ergonomics changes to workload presents a useful methodology for future work in this area, specific to health IT.CrossRef

37.

Kato-Lin YC, Krishnamurti L, Padman R, Seltman HJ. Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? A mixed methods evaluation. Int J Med Inform. 2014;83(11):814–24. https://doi.org/10.1016/j.ijmedinf.2014.08.003.CrossRefPubMed

38.

La Force C, Weinstein C, Nathan RA, Weinstein SF, Staudinger H, Meltzer EO. Patient satisfaction with a pressurized metered-dose inhaler with an integrated dose counter containing a fixed-dose mometasone furoate/formoterol combination. J Asthma. 2011;48(6):625–31. https://doi.org/10.3109/02770903.2011.587579.CrossRef

39.

Lemke DS, Fielder EK, Hsu DC, Doughty CB. Improved team performance during pediatric resuscitations after rapid cycle deliberate practice compared with traditional debriefing: a pilot study. Pediatr Emerg Care. 2016:1. https://doi.org/10.1097/PEC.0000000000000940.

40.

Lesselroth BJ, Yang J, McConnachie J, Brenk T, Winterbottom L. Addressing the sociotechnical drivers of quality improvement: a case study of post-operative DVT prophylaxis computerised decision support. BMJ Qual Saf. 2011;20(5):381–9. https://doi.org/10.1136/bmjqs.2010.042689.CrossRefPubMedPubMedCentral

41.

Linam WM, Margolis PA, Atherton H, Connelly BL. Quality-improvement initiative sustains improvement in pediatric health care worker hand hygiene. Pediatrics. 2011;128(3):e689–e98. https://doi.org/10.1542/peds.2010-3587.CrossRefPubMed

42.

Margolies R, Gurnaney H, Egeth M, Fink N, Soosaar J, Shames A, et al. Positioning patient status monitors in a family waiting room. Health Environ Res Des J. 2015;8(2):103–9. https://doi.org/10.1177/1937586714566407.CrossRef

43.

Marte A, Cavaiuolo S, Pintozzi L, Prezioso M, Nino F, Coppola S, et al. “Spaghetti maneuver”: a useful tool in pediatric laparoscopy—our experience. Afr J Paediatr Surg. 2011;8(2):252–5. https://doi.org/10.4103/0189-6725.86077.CrossRefPubMed

44.

Nadler I, Sanderson PM, Van Dyken CR, Davis PG, Liley HG. Presenting video recordings of newborn resuscitations in debriefings for teamwork training. BMJ Qual Saf. 2011;20(2):163–9. https://doi.org/10.1136/bmjqs.2010.043547.CrossRefPubMed

45.

Smith TJ, Schoenbeck K, Clayton S. Staff perceptions of work quality of a neonatal intensive care unit before and after transition from an open bay to a private room design. Work. 2009;33(2):211–27. https://doi.org/10.3233/WOR-2009-0868.

46.

Theilen U, Leonard P, Jones P, Ardill R, Weitz J, Agrawal D, et al. Regular in situ simulation training of paediatric Medical Emergency Team improves hospital response to deteriorating patients. Resuscitation. 2013;84(2):218–22. https://doi.org/10.1016/j.resuscitation.2012.06.027.

47.

Theilen U, Fraser L, Jones P, Leonard P, Simpson D. Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings. Resuscitation. 2017;115:61–7. https://doi.org/10.1016/j.resuscitation.2017.03.031.

48.

Vats A, Goin KH, Villarreal MC, Yilmaz T, Fortenberry JD, Keskinocak P. The impact of a lean rounding process in a pediatric intensive care unit. Crit Care Med. 2012;40(2):608–17. https://doi.org/10.1097/CCM.0b013e318232e2fc.

49.

Wilson BL, Phelps C, Downs B, Wilson K. Using human factors engineering in designing and assessing nursing personnel responses to mock code training. J Nurs Care Qual. 2010;25(4):295–303. https://doi.org/10.1097/NCQ.0b013e3181def0ba.CrossRefPubMed

50.

Wright SM. Examining transfer of care processes in nurse anesthesia practice: introducing the PATIENT protocol. AANA J. 2013;81(3):225–32.

51.

• Xie A, Carayon P, Cartmill R, Li Y, Cox ED, Plotkin JA, et al. Multi-stakeholder collaboration in the redesign of family-centered rounds process. Appl Ergon. 2015;46(Part A):115–23. https://doi.org/10.1016/j.apergo.2014.07.011. Xie et al study provides an example of a successful intervention that targets both clinical and non-clinical participants. More recently healthcare is conceptualized as a continuum and this study paves a way forward to understanding the interactions between clinical and nonclinical stakeholders in patient safety.

52.

Werner NE, Nelson ET, Boehm-Davis DA. Human factors methods to reduce medication error: using task analysis in a pediatric and adult pharmacy. Work. 2012;41(Supplement 1):5665–7.PubMed

53.

Rivera-Rodriguez A, Karsh B-T. Interruptions and distractions in healthcare: review and reappraisal. BMJ Qual Saf. 2010; qshc. 2009.033282.

54.

•• Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, et al. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics. 2013;56(11):1669–86. The SEIPS 2.0 framework highlights the importance of patient work in patient safety. The paper extends the boundaries of healthcare beyond clinical settings and suggests that care activities outside inpatient settings need to be accounted for when designing HFE interventions.CrossRef

55.

Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SK, Simon TD, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics. 2011; peds. 2010–0910.

56.

•• Valdez RS, McGuire KM , Rivera AJ. Qualitative ergonomics/human factors research in health care: Current state and future directions. Appl Ergon. 2017;62:43–71. This study provides a review of all the HFE studies that have applied qualitative methods this far. Qualitative inquiry can be an important and valuable form of research when deemed appropriate to understand the differences between work as imagined vs. work as done. Further this study highlights the areas of healthcare where more work can be done using qualitative methods.CrossRefPubMed

57.

• Khunlertkit A, Rivera AJ, Yin S, Dulude C, Regli SH, Wolf L, editors. Human factors in the wild: getting the human factors foot in the healthcare door. (Discussion Panel). Proceedings of the Human Factors and Ergonomics Society Annual Meeting; 2016: SAGE Publications Sage CA: Los Angeles, CA. This panel discusses the challenges of integrating HFE as part of an existing healthcare organization. Although, there are many benefits of HFE, getting support from leadership of quality and safety groups as well as executives in an organization is extremely difficult. This panel provides strategies that have been successful for HFE integration.

58.

• Khunlertkit A, Yin S, Rivera AJ, Tremoulet P, Won J, Tran G et al., editors. Human factors in the wild delivering safety in the pediatric world (Discussion Panel). Proceedings of the Human Factors and Ergonomics Society Annual Meeting; 2017: SAGE Publications Sage CA: Los Angeles, CA. This panel provides insight on challenges of pediatrics. While it is difficult to integrate HFE in general, this study takes the discussion further highlighting the special needs of the pediatric population and how those barriers can be overcome.

59.

Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008;3(1):1.CrossRefPubMedPubMedCentral

Titel: Human Factors Engineering: Status, Interventions, Future Directions in Pediatrics
verfasst von: Siddarth Ponnala, MS
A. Joy Rivera, PhD
Publikationsdatum: 01.06.2019
Verlag: Springer International Publishing
Erschienen in: Current Treatment Options in Pediatrics / Ausgabe 2/2019
Elektronische ISSN: 2198-6088
DOI: https://doi.org/10.1007/s40746-019-00157-4

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Human Factors Engineering: Status, Interventions, Future Directions in Pediatrics