Megan Salwei

• Doctor of Philosophy
• Research Assistant Professor at Vanderbilt University

Background: The integration of artificial intelligence (AI) in health care settings demands a nuanced approach that considers both technical performance and sociotechnical factors. Objective: This study aimed to develop a checklist that addresses the sociotechnical aspects of AI deployment in health care and provides a structured, holistic guide...

Objectives Research on the Epic Sepsis System (ESS) has predominantly focused on technical accuracy, neglecting the user experience of healthcare professionals. Understanding these experiences is crucial for the design of Artificial Intelligence (AI) systems in clinical settings. This study aims to explore the socio-technical dynamics affecting ESS...

Objective Decision support can improve shared decision-making for breast cancer treatment, but workflow barriers have hindered widespread use of these tools. The goal of this study was to understand the workflow among breast cancer teams of clinicians, patients, and their family caregivers when making treatment decisions and identify design guideli...

This study underscores the complexities of implementing AI in clinical care, advocating for a holistic approach that combines technical and sociotechnical elements. It stresses aligning AI tool values with health care provider and patient needs, ensuring enhancement of patient care, compliance with standards, and seamless workflow integration. Chal...

While numerous decision aids have been developed to support treatment decision-making in breast cancer1, widespread implementation remains limited due to challenges integrating these tools in clinical workflows2. Given these persistent issues, we need to better understand the complex workflows and needs of decision aid users - patients, their famil...

The prevalence of artificial intelligence (AI) is rapidly growing across industries including in health care. AI has the potential to improve patient safety (e.g., diagnostic error) and reduce clinician workload (e.g., documentation burden) and healthcare costs. Yet, many questions remain about how clinicians will interact with and use AI to suppor...

Purpose of review This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists’ decision-making. Recent findings Naturalistic decision-making, a rich research field that aims to understand how cognitive work is accomplished in complex environments, provides insight into anesthesiologists’ decisio...

With the growing implementation and use of health IT such as Clinical Decision Support (CDS), there is increasing attention on the potential negative impact of these technologies on patients (e.g., medication errors) and clinicians (e.g., increased workload, decreased job satisfaction, burnout). Human-Centered Design (HCD) and Human Factors (HF) pr...

Cognitive task analysis (CTA) methods are traditionally used to conduct small-sample, in-depth studies. In this case study, CTA methods were adapted for a large multi-site study in which 102 anesthesiologists worked through four different high-fidelity simulated high-consequence incidents. Cognitive interviews were used to elicit decision processes...

Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision-making to improve patient-centered care. However, widespread adoption of shared decision-making into clinical care has been limited. Shared decision-making is a proc...

1558 Background: Almost 4 million women in the US have had breast cancer, with 300,000 women diagnosed each year. Treatment decision-making following breast cancer diagnosis can be challenging as there are often several clinically appropriate treatment options, each with differing impacts on patient short- and long-term quality of life. Further, pa...

Background: Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved,...

Effective decision-making in crisis events is challenging due to time pressure, uncertainty, and dynamic decisional environments. We conducted a systematic literature review in PubMed and PsycINFO, identifying 32 empiric research papers that examine how trained professionals make naturalistic decisions under pressure. We used structured qualitative...

Objective: Nonroutine events (NREs, i.e., deviations from optimal care) can identify care process deficiencies and safety risks. Nonroutine events reported by clinicians have been shown to identify systems failures, but this methodology fails to capture the patient perspective. The objective of this prospective observational study is to understand...

BACKGROUND Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. Incorporating diverse expertise, especially in healthcare contexts, can help assess and address potential negative impacts on patient safety. OBJECTIVE To assess a multi-stage method for integrating diverse expertise (i.e.,...

Background: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potent...

Metastatic breast cancer (MBC) is incurable breast cancer (i.e., stage IV) affecting approximately 165,000 women in the US, some of whom will live for years with MBC. Survivors living with MBC frequently experience functional impairments and sickness relating to treatment and their disease progression. Unlike “curable” cancers, MBC survivors are li...

e13567 Background: Patients (pts) with cancer in the outpatient setting are at a high-risk for adverse events, such as unplanned hospitalizations and ER visits. A recent study found that up to 30% of hospital admissions were preventable. Identifying pts at risk of avoidable clinical deterioration remains a challenge, as clinicians may not be aware...

Objective: To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits. Background: Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughou...

In the coming years, artificial intelligence (AI) will pervade almost every aspect of the health care delivery system. AI has the potential to improve patient safety (e.g., diagnostic accuracy) as well as reduce the burden on clinicians (e.g., documentation-related workload); however, these benefits are yet to be realized. AI is only one element of...

Objective To evaluate the usability and use of human factors (HF)–based clinical decision support (CDS) implemented in the emergency department (ED). Background Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support p...

Of the 3 million older adults seeking fall-related emergency care each year, nearly one-third visited the Emergency Department (ED) in the previous 6 months. ED providers have a great opportunity to refer patients for fall prevention services at these initial visits, but lack feasible tools for identifying those at highest-risk. Existing fall scree...

Background Health IT, such as clinical decision support (CDS), has the potential to improve patient safety. However, poor usability of health IT continues to be a major concern. Human factors engineering (HFE) approaches are recommended to improve the usability of health IT. Limited evidence exists on the actual impact of HFE methods and principles...

This chapter shows how the human factors and ergonomics (HFE) discipline can provide concepts, methods, and information for analyzing and redesigning health care systems and processes for the benefits of all involved, e.g., patients, caregivers, physicians, nurses, and other health care workers. It reviews dimensions of quality of care, and dedicat...

Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. We propose a definition and conceptual model of health IT workflow integration....

The macroergonomics perspective on patient work emphasizes that work performed by patients and their informal caregivers is performed in a work system that has multiple elements (people, tasks, technologies, and physical, social and organizational environment). Patient work is done at multiple system levels of direct care level, organizational leve...

Based on our analysis of descriptions provided by four EHR vendors on their EHR usability efforts, we provide three recommendations aimed at improving the usability of health information technology and reducing clinician burnout. First, EHR vendors need to dedicate increased attention to the design of the entire sociotechnical (work) system, includ...

It is critical to understand, analyze and improve the work system of medical residents in order to support the care processes in which they are involved, as well as their educational processes. The discipline of human factors (or ergonomics) (HFE) provides systems concepts and methods to improve the multi-faceted work system of medical residents an...

Disposition decision-making in the emergency department (ED) is critical to patient safety and quality of care. Disposition decision-making has particularly important implications for older adults who comprise a significant portion of ED visits annually and are vulnerable to suboptimal outcomes throughout ED care transitions. We conducted a seconda...

Older adults frequently visit the emergency department (ED) and participate in multiple transitions of care following an ED visit. These transitions of care, e.g. to hospital, long-term care facility or home, represent patient safety risks because of communication and coordination failures between the various roles involved, but also provide opport...

Objective In this study, we used human factors (HF) methods and principles to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. We hypothesised that the application of HF methods and principles will produce a more usable CDS that im...

The emergency department (ED) is a complex environment where diagnoses must often be made quickly, based on incomplete information. Pulmonary embolism (PE) is an especially challenging diagnosis that is frequently delayed or missed due to its non-specific symptoms, and can be life-threatening when not treated. Clinical decision supports (CDS) have...

Designing and implementing clinical decision support (CDS) in health care has been challenging. Attempts have been made to design and implement CDS to support clinical procedures, but many of these CDSs have met user resistance. One possible explanation for the lack of acceptability can be the poor design of the CDS. In this study, we describe the...

Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient’s hospitalisation, presenting five stages with different...

Intensive care units (ICUs) are complex environments, which rely on teams in order to coordinate patient care. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major concern for ICU patients, who are frequently immobile. VTE prophylaxis (prevention) occurs throughout different stages of a pat...

Despite progress on patient safety since the publication of the Institute of Medicine's 1999 report, To Err Is Human, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex in...