“…Focus groups were scheduled during shift overlap, staff development sessions and education forums to enable as many staff as possible to attend. An interview schedule guided discussion with items based on a review of the literature and from evaluations of early chart versions22 24 29 33 34 (see box 1). Trigger questions for semistructured focus groups
How did you find using the new charts?
…”
Section: Methodsmentioning
confidence: 99%
“…An optimal TTS incorporates specific design features based on human factors’ principles to minimise any risk of error29; these characteristics include: separate graphing areas for core vital signs; indication of abnormal thresholds, with colours and a visual layout to minimise risk of error during documentation and alert and prompt staff to escalate care; and recommendations for appropriate actions according to a patient's deteriorating condition 6…”
BackgroundOptimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger ‘Observation and Response Charts’ were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards.MethodsAcross eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2–6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach.FindingsIn this exploration of initial user experiences, key emergent themes were: tensions between vital sign ‘ranges versus precision’ to support decision making; using a standardised ‘generalist chart in a range of specialist practice’ areas; issues of ‘clinical credibility’, ‘professional autonomy’ and ‘influences of doctors’ when communicating abnormal signs; and ‘permission and autonomy’ when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of ‘increased activity/uncertain benefit’ was uncovered.ConclusionsFindings particularly reinforced the significant influences of organisational work-based cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design characteristics will be possible when these broader cultural issues are addressed.
“…Focus groups were scheduled during shift overlap, staff development sessions and education forums to enable as many staff as possible to attend. An interview schedule guided discussion with items based on a review of the literature and from evaluations of early chart versions22 24 29 33 34 (see box 1). Trigger questions for semistructured focus groups
How did you find using the new charts?
…”
Section: Methodsmentioning
confidence: 99%
“…An optimal TTS incorporates specific design features based on human factors’ principles to minimise any risk of error29; these characteristics include: separate graphing areas for core vital signs; indication of abnormal thresholds, with colours and a visual layout to minimise risk of error during documentation and alert and prompt staff to escalate care; and recommendations for appropriate actions according to a patient's deteriorating condition 6…”
BackgroundOptimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger ‘Observation and Response Charts’ were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards.MethodsAcross eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2–6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach.FindingsIn this exploration of initial user experiences, key emergent themes were: tensions between vital sign ‘ranges versus precision’ to support decision making; using a standardised ‘generalist chart in a range of specialist practice’ areas; issues of ‘clinical credibility’, ‘professional autonomy’ and ‘influences of doctors’ when communicating abnormal signs; and ‘permission and autonomy’ when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of ‘increased activity/uncertain benefit’ was uncovered.ConclusionsFindings particularly reinforced the significant influences of organisational work-based cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design characteristics will be possible when these broader cultural issues are addressed.
“…We identified a total of twelve projects with 23 studies that showed the breadth of HFE applications to healthcare system redesign. We found evidence of the effectiveness of HFE in improving quality of care, such as reduced task completion time (Chan et al 2010; Chan et al 2011a; Christofidis et al 2013; Johnson, Johnson and Zhang 2005; Lin, Vicente and Doyle 2001; Preece et al 2012; Rousek and Hallbeck 2011), decreased error rate (Chan et al 2010; Christofidis et al 2013; Kobayashi et al 2011; Kobayashi et al 2013; Lin, Vicente and Doyle 2001; Preece et al 2012), and improved compliance with best practices (de Korne et al 2012; de Vries et al 2009; Lesselroth et al 2011). There was also evidence of HFE-based interventions’ impact on patient safety, such as decreased complication rate (de Vries, Prins , et al 2010), decreased in-hospital mortality (de Vries, Prins , et al 2010), and increased self-efficacy of patients (Eames et al 2013; Hoffmann et al 2007).…”
Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.
Practitioner Summary
Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities.
“…The resulting adult deterioration detection system (ADDS) charts were designed with a multiparameter early warning scoring system (EWSS) using heuristic analysis [11] and were tested in a simulated environment [11,13-15]. The EWSS assigned scores from 0-5 for specified clinical parameters (described below), according to the level of derangement from normal, and then summed to produce a total score.…”
BackgroundClinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs.ObjectiveTo describe the study protocol for the clinical testing of these observation and response charts (ORCs).MethodsWe propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site’s existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources.ResultsSite selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress.ConclusionsThis detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.
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