OBJECTIVE To identify issues during donning and doffing of personal protective equipment (PPE) for infectious diseases and to inform PPE procurement criteria and design. DESIGN A mixed methods approach was used. Usability testing assessed the appropriateness, potential for errors, and ease of use of various combinations of PPE. A qualitative constructivist approach was used to analyze participant feedback. SETTING Four academic health sciences centers: 2 adult hospitals, 1 trauma center, and 1 pediatric hospital, in Toronto, Canada. PARTICIPANTS Participants (n=82) were representative of the potential users of PPE within Western healthcare institutions. RESULTS None of the tested combinations provided a complete solution for PPE. Environmental factors, such as anteroom layout, and the design of protocols and instructional material were also found to impact safety. The study identified the need to design PPE as a complete system, rather than mixing and matching components. CONCLUSIONS Healthcare institutions are encouraged to use human factors methods to identify risk and failure points with the usage of their selected PPE, and to modify on the basis of iterative evaluations with representative end users. Manufacturers of PPE should consider usability when designing the next generation of PPE. Infect Control Hosp Epidemiol 2016;37:1022-1028.

OBJECTIVE To explore the impact of environmental design on doffing personal protective equipment in a simulated healthcare environment. METHODS A mixed-methods approach was used that included human-factors usability testing and qualitative questionnaire responses. A patient room and connecting anteroom were constructed for testing purposes. This experimental doffing area was designed to overcome the environmental failures identified in a previous study and was not constructed based on any generalizable hospital standard. RESULTS In total, 72 healthcare workers from Ontario, Canada, took part in the study and tested the simulated doffing area. The following environmental design changes were tested and were deemed effective: increasing prominence of color-coded zones; securing disinfectant wipes and hand sanitizer; outlining disposal bins locations; providing mirrors to detect possible contamination; providing hand rails to assist with doffing; and restricting the space to doff. Further experimentation and iterative design are required with regard to several important features: positioning the disposal bins for safety, decreasing the risk of contamination and user accessibility; optimal positioning of mirrors for safety; communication within the team; and positioning the secondary team member for optimal awareness. Additional design suggestions also emerged during this study, and they require future investigation. CONCLUSIONS This study highlights the importance of the environment on doffing personal protective equipment in a healthcare setting. Iterative testing and modification of the design of the environment (doffing area) are important to enhancing healthcare worker safety. Infect Control Hosp Epidemiol 2017;38:712-717.

Background: Integrated bedside terminals (IBTs) were implemented at Humber River Hospital with the goal of supporting patient independence and autonomy and improving nursing workflows. The IBTs provide access to a range of convenience and entertainment services as well as access to personal health information. Due to the novelty of the technology, there is a paucity of empirical data on patients' use of, satisfaction with and perceptions of bedside terminals. Aim: The purpose of this study was to evaluate the impact of IBTs on patient empowerment and nursing workflows. Methods: A mixed methods design was employed using a cross-sectional patient survey and semi-structured interviews with nurses. The patient survey assessed patient empowerment and satisfaction with the range of services offered through the IBT. Patient scores were summarized using descriptive statistics. Additionally, face-to-face interviews with nurses were used to illicit feedback regarding the IBTs' impacts on nursing workflows. Results: In total, 113 patients and 11 nurses participated in the study. Analysis of patient satisfaction surveys indicated that the IBTs enhanced the patient experience and increased self-care management. Nurses reported that the IBTs helped patients feel comfortable and entertained and helped enhance the nurse-patient relationship. However, nurses also expressed concern that elderly patients were less inclined to use the IBT.

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.

As with many aspects of our personal and professional lives, the COVID-19 pandemic has impacted the way that human factors researchers and specialists are able to conduct their work. As an organization providing human factors, patient safety, and risk management support nationally to healthcare institutions, we have had to adapt our established processes to find innovative solutions to continue our research and our work. Namely, we have had to work remotely from our partners and collaborators, which severely restricts opportunities for field work and first-hand observations. Besides the obvious challenges with technology and connectivity issues, we had to be mindful of our stakeholders and participants knowing that ‘Zoom fatigue’ was and continues to impact individuals both mentally and physically. As well, as practitioners we feel restricted in building a rapport with various end users, which is an essential component for understanding the stakeholder needs. In this talk, we present a number of strategies and best practices, including the use of electronic tools and tips for engagement and collaboration during virtual sessions. As well, we highlight the new opportunities that remote work affords the human factors specialist.We present these techniques within the context of patient safety projects conducted over the past year. In 2021, we partnered with a healthcare delivery institution to conduct a virtual Failure Mode and Effects Analysis (FMEA). The FMEA was conducted remotely via Zoom with five two-hour sessions, as physical distancing rules were in effect. In order to balance time commitments and Zoom fatigue, two-hour sessions were found to be sufficient for productive discussions while also respecting stakeholders’ schedules and care responsibilities. Furthermore, we decided on a dedicated facilitator to avoid cognitive overload and to avoid having to time-share between a number of responsibilities at the expense of a productive conversation. In the full talk, we discuss a number of other strategies on using technological aids to facilitate discussion, maintaining an amicable and open work environment, and staying on schedule. As well, we discuss the opportunities afforded by remote work, such as being able to provide support to a large number of organizations across the country without the overhead of travel.We anticipate that hybrid and remote work will continue to be part of the work reality for human factors specialists in healthcare for the foreseeable future. We have adopted these techniques into our standard practice, and believe that human factors practitioners will value hearing details about conducting these sessions in a remote setting. In particular, we provide lessons learned for scheduling and preparing for the sessions, collecting user data using a web-based voting system, and the challenges of logistics of running remote sessions. These will be practical and useful for specialists and researchers planning to conduct remote sessions with healthcare providers.