Use of in situ simulation and human factors engineering to assess and improve emergency department clinical systems for timely telemetry-based detection of life-threatening arrhythmias

Abstract

Background and objectives Medical simulation and human factors engineering (HFE) may help investigate and improve clinical telemetry systems. Investigators sought to (1) determine the baseline performance characteristics of an Emergency Department (ED) telemetry system implementation at detecting simulated arrhythmias and (2) improve system performance through HFE-based intervention. Methods The prospective study was conducted in a regional referral ED over three 2-week periods from 2010 to 2012. Subjects were clinical providers working at the time of unannounced simulation sessions. Three-minute episodes of sinus bradycardia (SB) and of ventricular tachycardia (VT) were simulated. An experimental HFE-based multi-element intervention was developed to (1) improve system accessibility, (2) increase system relevance and utility for ED clinical practice and (3) establish organisational processes for system maintenance and user base cultivation. The primary outcome variable was overall simulated arrhythmia detection. Pre-intervention system characterisation, post-intervention end-user feedback and real-world correlates of system performance were secondary outcome measures. Results Baseline HFE assessment revealed limited accessibility, suboptimal usability, poor utility and general neglect of the telemetry system; one simulated VT episode (5%) was detected during 20 pre-intervention sessions.

An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review

“…Twenty studies were controlled studies [25–27,29,32,34,36–44,46,48,49,51,52], two of which were RCTs [44, 51]. The other eight studies were before/after surveys, without a control group [28, 30, 31, 33, 35, 45, 47, 50]. The target populations were staff working in hospitals and nursing homes, including nurses [35, 37–39, 41–43, 45, 47–49, 51], surgeons (3 studies) [27, 44, 46], medical students (4 studies) [25,32,36,52] and other health care workers (8 studies) [26, 28–30, 33–34, 40, 50].…”

“…The target populations were staff working in hospitals and nursing homes, including nurses [35, 37–39, 41–43, 45, 47–49, 51], surgeons (3 studies) [27, 44, 46], medical students (4 studies) [25,32,36,52] and other health care workers (8 studies) [26, 28–30, 33–34, 40, 50]. Seventeen studies reported their funding resources [26, 28–31, 33–37, 43, 45–49, 52] and eleven were supported by public funding [26–28, 32–35,41,43–44,46]. Nine studies did not report funding source [27, 32, 38–40, 42,44–45,51].…”

Human Factors and Simulation in Emergency Medicine

“…10,11 The Food and Drug Administration (FDA) has developed HF guidelines to assist with the design and development of medical devices. 12 Kobayashi et al 13 studied the addition of an automatic external defibrillator (AED) to standard defibrillator-based response systems using simulated in situ cases.…”

“…47 Patient telemetry monitoring, a complex clinical process, exemplifies an active area of HF-based research, with a focus on alarm fatigue 48 and the timely detection of life-threatening arrhythmias. 11 There is growing interest in understanding how ED clinicians interact with their work environment through ergonomic and safety analyses of the ED [49][50][51] and through the study of health information technology systems such as patient tracking boards 52,53 and electronic health records. 54 HF has been used in device design within the ED to create a work surface to replace the Mayo stand.…”

Improving performance through human-centred reconfiguration of existing designs

“…In this issue, Kobayashi and colleagues25 describe an intervention to do just that. They demonstrate improvements in performance with an existing technology by reconfiguration based on human factors engineering principles.…”