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ABSTRACT: Hospital-acquired venous thromboembolism (VTE) is a common and preventable adverse event that most patients are at risk of developing during their hospital stay. VTE prophylactic anticoagulation (chemoprophylaxis) is the preferred pharmacological assignment for reducing risk of VTE, but it is underused in current practices involving risk stratification (RS) for VTE prevention. The purpose of this study was to determine whether a protocol that eliminates the RS step (non-RS protocol) is more likely to lead residents to evidence-based VTE assignment than the currently used RS protocol. The non-RS protocol follows a methodology that reduces complexity by assuming that the risk of VTE is present and uses contraindications to determine appropriate VTE assignment.
In 2009, 41 medicine residents at the Nebraska Western Iowa Veterans Affairs clinic participated in an online comparison of two different protocols (RS and non-RS) for assigning chemoprophylaxis for VTE. Six validated, hypothetical patient scenarios were used to compare appropriate (evidence-based) VTE assignments for VTE and completion times for each protocol.
Statistical analyses found that the non-RS protocol produced significantly faster (P < .001) scenario completion times and significantly more (P < .001) appropriate VTE assignments than the RS protocol for four of the six patient scenarios.
This study used a new, streamlined protocol (non-RS), which improved VTE assignment and the use of chemoprophylaxis and simplified the process when compared with the use of a traditional RS protocol.
Academic medicine: journal of the Association of American Medical Colleges 12/2011; 86(12):1518-24. · 2.34 Impact Factor
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ABSTRACT: This study utilized usability testing and human factors engineering (HFE) principles to create efficient code cart medication drawer modifications to improve code blue medical emergency (code) medication management.
Effective access to medications during a code is a key component in delivering optimal care and has been found to be a major problem among health care organizations; however, little research has been conducted to improve the efficiency of medication management during a code.
A total of 26 health care professionals (13 pharmacists and 13 nurses) were asked to locate items within a code cart medication drawer during two independent simulated code scenarios alternately using either a baseline medication drawer (control; Drawer 1) or a prototype medication drawer (prototype; Drawer 2), which was developed using HFE principles and usability testing. Overall medication retrieval time, wasteful actions, and survey responses were recorded.
Drawer 2 had significantly faster trial completion times (p = .005) and fewer wasteful actions (p < .001) compared to Drawer 1. Participant survey results rated Drawer 2 (prototype) significantly higher (more favorable) for medication drawer visibility (p < .001), usability (p = .011), and organization (p < .001) compared to Drawer I (baseline).
The HFE redesign concepts incorporated into Drawer 2 (consisting of visibility, grouping, and organization) produced successful, low-cost, and generalizable modifications that can improve patient care.
The findings demonstrate that HFE and usability applied to code cart design are effective, are customizable, and can affect patient safety by saving valuable time and reducing wasted motions (including errors) during code situations.
Human Factors The Journal of the Human Factors and Ergonomics Society 12/2011; 53(6):626-36. · 1.19 Impact Factor
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ABSTRACT: Abstract In laparoscopic surgery, electrosurgical equipment is operated by means of one or more foot pedals positioned on the floor in front of the surgeon causing poor ergonomic posture and physical discomfort. The focus of this study was to ergonomically explore the integration of electrosurgical hand controls within the previously designed Intuitool™ laparoscopic surgical instrument to optimize functionality. Three different hand control designs (CDs) were implemented within the Intuitool™ and each CD contained the standard cutting and coagulation features, previously operated by foot pedals. This study used 26 right-handed participants, with no previous laparoscopic surgery experience. The participants completed simple tasks using all three CDs within a simulated abdomen. Electromyography (EMG) sensors and force sense resistors (FSRs) were utilized to measure muscle activity and button actuation force, respectively. A questionnaire was also utilized to measure comfort level of each CD. The results indicated that the close proximity of CD 1 generated greater actuation force for all tasks, was rated easier to use (P = 0.003) and was preferred more frequently by the participants (53.8%) compared to CD 2 and 3. As a result, CD 1 was determined to be an optimal ergonomic design for electrosurgical hand controls within the Intuitool™.
Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 09/2011; 21(3):222-33. · 1.33 Impact Factor
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ABSTRACT: The aim of this study was to quantitatively and qualitatively determine the optimal ergonomic placement of novel electrosurgical hand controls integrated into a standard laparoscopic grasper to optimize functionality. This device will allow laparoscopic surgeons to hand-operate standard electrosurgical equipment, eliminating the use of electrosurgical foot pedals, which are prone to activation errors and cause uncomfortable body positions for the physician. Three hand control designs were evaluated by 26 participants during the performance of four basic inanimate laparoscopic electrosurgical tasks. Task completion time, actuation force, forearm electromyography (EMG) and user preference were evaluated for each hand control design. Task speed was controlled using a metronome to minimize subject variability, and resulted in no significant completion time differences between task types (P > 0.05). Hand control design 1 (CD 1) resulted in the ability to generate significantly greater actuation force for three of the four tasks (P < 0.05) with minimal forearm muscle activation. Additionally, CD 1 was rated significantly better for comfort and ease-of-use compared to the other two hand control designs (P < 0.05). As a result, CD 1 was determined to be an advantageous ergonomic design for the novel electrosurgical hand controls.
Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 03/2011; 20(6):321-8. · 1.33 Impact Factor
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ABSTRACT: As people age, they not only face declining vision, but, due to physiology, increased health problems which necessitate way-finding through healthcare facilities. In this pilot study on way-finding in a hospital setting, 50 healthy, sighted participants donned one of five commonly encountered low-vision impairment simulators. Each tried to find their way along common hospital paths. Data on the obstacles the participants faced was gathered objectively via observation as well as subjectively by post-scenario questionnaires. The results of the study show that for low-vision people, decorative elements often create major disturbances in way-finding. Combined with other age related conditions, this may put patients at a high risk of tripping and falling. In addition, changes in lighting often are misleading and may cause corridors to appear crooked or doorways to appear larger/smaller than they are. The sizes of text on signs as well as the placement, illumination and size of the signs themselves may be unsatisfactory. Most of these problems can easily be detected by the use of low-vision simulation, then categorized and eliminated. Hospitals can improve their facility to reduce potential slips and falls as well as frustration using these data.
Studies in health technology and informatics 02/2009; 142:133-5.
