Robert Wears

Robert Wears
University of Florida | UF · Department of Emergency Medicine

MD, PhD

About

289
Publications
76,264
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
12,136
Citations
Additional affiliations
August 2004 - present
Imperial College London
Position
  • Professor

Publications

Publications (289)
Article
Full-text available
We describe the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. Emergency medicine physicians and nurses were observed for 2 h periods. Researchers used paper notes to document the characteristics (e.g., partners involved, location of communication, who initiated c...
Article
Developing novel interfaces for high-risk situations, such as the Emergency Department, requires a sufficient quantity of detailed patient data to support usability and evaluation activities, yet patient privacy restrictions often prevent the use of actual patient data for these activities. We developed a synthetic dataset to provide a suitable alt...
Article
Although the use of resilience skills (RSs) by emergency department (ED) front-line staff is ubiquitous, the nature and origin of these skills tend to be taken for granted. This study investigates the research question “where do RSs come from”? Case studies in two EDs were undertaken in order to answer the research question: one in Brazil and the o...
Article
This essay describes the ramifying influence of Jens Rasmussen, illustrating how his work lives on through people whom he has influenced, even though they may have never directly collaborated. I approach this in three ways: a social network analysis of the ‘Rasmussen number’ (an analogue of the Erdös number); and two citations network analyses base...
Article
The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-...
Article
Full-text available
Background: Overuse of computed tomography (CT) for minor head injury continues despite developed and rigorously validated clinical decision rules like the Canadian CT Head Rule (CCHR). Adherence to this sensitive and specific rule could decrease the number of CT scans performed in minor head injury by 35%. But in practice, the CCHR has failed to...
Article
The default for the Commenting tool bar is set to 'off' in version 9. To change this setting select 'Edit | Preferences', then 'Documents' (at left under 'Categories'), then select the option 'Never' for 'PDF/A View Mode'. (Changing the default setting, Adobe version 9) To make annotations in the PDF file, open the PDF file using Adobe Reader XI, c...
Article
Full-text available
The Critical Incident Technique (CIT) and the Critical Decision Method (CDM) have been employed successfully to elicit information about human activities, explicate expert knowledge and model decision-making in various domains. Because of their proven efficacy in naturalistic settings, we adapted these methods to develop a script for interviews abo...
Article
Full-text available
The current approach to patient safety, labelled Safety I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what...
Article
There has been momentum to quickly develop health information technology (IT), but these developments may not result in the expected benefits if the IT is not designed to support caregivers. This research aimed to create an interface for emergency department tracking and control using cognitive systems engineering methods. Comparison of the novel d...
Article
This paper presents an empirical case study to illustrate, corroborate, and perhaps extend some key generalizations about resilient performance in complex adaptive systems. The setting is a pediatric hematology/oncology pharmacy, a complex system embedded in the larger complex of the hospital, which provides chemotherapy and other high risk medicat...
Article
Full-text available
Two related papers1 ,2 in this issue of BMJ Quality & Safety provide interesting insights into the difficulties of evaluating improvement activities, and also illustrate why improvement is so hard. In a carefully crafted set of controlled, interrupted time series experiments, the authors examined the effectiveness in the operating theatre of two po...
Article
Full-text available
In discussions of the quality and safety problems of modern, Western healthcare, one of the most frequently heard criticisms has been that: "It is not standardised." This paper explores issues around standardisation that illustrate its surprising complexity, its potential advantages and disadvantages, and its political and sociological implications...
Technical Report
Full-text available
The publication of the IOM report To Err is Human in 2000 served as a catalyst for a growing interest in improving the safety of health care. Yet despite decades of attention, activity and investment, improvement has been glacially slow. Although the rate of harm seems stable, increasing demand for health services, and the increasing intensity and...
Chapter
Patients and family members/caregivers are an integral part of everyday clinical work. Yet, for much of the modern era they were regarded as silent participants, with little to contribute to their care. Only recently have patients been considered knowledgeable or having the expertise to engage in self-management of chronic conditions. With experien...
Article
Full-text available
Over the last few years, patient safety research has seen a paradigm-shift marked by the advent of Resilience Engineering (RE). Findings from the team’s previous research on the efficacy of root-cause analysis in improving patient safety revealed the potential to analyze existing resilient system properties and leverage the same in system-design an...
Article
is apattern of fantasy and projection on the part of informationtechnologyadvocates.Fordecades,wehaveheardthetechnofantasythatthepresentproblemsofcomputerizationwillbesolvedbymorecomputerization: in particular the “next generation” of computers,operating systems, applications, or users. If fantasy is insufficient,then projection isanother defense, t...
Article
This paper examines how the syndrome of authoritarian high modernism, described in detail in the public policy sphere in James C Scott’s Seeing Like a State, serves as the dominant, orthodox ideology informing patient safety. We compare Scott’s conceptual framework to the currently dominant health care safety practices to surface foundational issue...
Article
Full-text available
When transferring patient care responsibilities across the healthcare continuum, clinicians strive to communicate safely and effectively, but communication failures exist that threaten patient safety. Although researchers are making great strides in understanding and solving intraservice handoff problems, inter-service transition communication rema...
Article
Full-text available
This paper presents the results of a usability evaluation conducted of an electronic Emergency Department information system (EDIS) prototype that was designed using a cognitive system engineering (CSE) approach. Participants were asked to complete tasks using the EDIS prototype, while thinking aloud about their interactions with the displays. Part...
Article
At our institution, we observed an increase in opioid-related adverse events after instituting a new pain treatment protocol. To prevent this, we programmed the Omnicell drug dispensing system to page the RRT whenever naloxone was withdrawn on the general wards. Retrospective review of a prospectively collected database with a before and after desi...
Article
Background: Previous studies suggest a relationship between chloride-rich intravenous (IV) fluids and acute kidney injury in critically ill patients. Objectives: To evaluate the relationship of IV fluid chloride content to kidney function in patients with severe sepsis or septic shock. Methods: A retrospective chart review was performed to determin...
Conference Paper
Introduction: Severe sepsis is a prevalent disease with approximately 30% mortality. Currently, resuscitative efforts aim to achieve predefined hemodynamic and physiologic goals. The role of CO2 metabolism as reflected by arterial CO2 (PaCO2), central venous CO2 (CvCO2), and end tidal CO2 (ETCO2) is less well understood. Our goal was to determine t...
Data
Full-text available
Conference Paper
Full-text available
A strength of the field of cognitive engineering and decision-making lies in its wide applica-bility across the complex socio-technical systems, which are ubiquitous in modern society. Meth-ods and theoretical advances in CEDM have been both developed through, and adapted across, domains as diverse as nuclear power, health systems, and aviation. Wh...
Conference Paper
Root Cause analysis (RCA) is a widely implemented event-analysis tool in healthcare, used to improve pa-tient safety. Several studies have assessed the effectiveness of RCA solutions and provided recommenda-tions for improving the approach; however few have suggested a systematic approach to align RCA-based interventions with the realities of work...
Article
Root cause analysis (RCA) after adverse events in healthcare is a standard practice at many institutions. However, healthcare has failed to see a dramatic improvement in patient safety over the last decade. In order to improve the RCA process, this study used systems safety science, which is based partly on human factors engineering principles and...
Article
Human Factors and Ergonomics (HFE) researchers have a long tradition of focusing on the individual or micro-level. However, HFE researchers have started expanding their focus to include organizational or macro-level factors. That said, a gap still exists of theories or models that explain the link between micro and macro variables. Identifying thes...
Article
Rapid response teams (RRTs) are frequently employed to respond to deteriorating inpatients. Proactive Rounding (PR) consists of the RRT nurse rounding through the inpatient wards identifying high risk patients and intervening preemptively. At our institution, PR began in July of 2007. Our objective was to determine the effect of PR by the RRT at ou...
Article
Health IT systems are often designed without a sufficient understanding of the clinical activities they are intended to support; thus desired benefits in quality of care, safety, and efficiency may not accrue. We present the second part of a multi-phase study which utilizes cognitive systems engineering (CSE) methods to design and test novel user i...
Article
Full-text available
Background Interest in human factors has increased across healthcare communities and institutions as the value of human centred design in healthcare becomes increasingly clear. However, as human factors is becoming more prominent, there is growing evidence of confusion about human factors science, both anecdotally and in scientific literature. Some...
Book
Full-text available
Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean production, and high reliability. This has on the wh...
Article
Background Cincinnati Children's Hospital is one of the busiest paediatric emergency departments (ED) in the USA; high volume, high acuity and frequent interruptions contribute to an increased risk for error. Objective To improve patient safety in a paediatric ED by implementing a multidisciplinary, simulation-based curriculum emphasising teamwork...
Article
Objective: Implement and demonstrate feasibility of in situ simulations to identify latent safety threats (LSTs) at a higher rate than lab-based training, and reinforce teamwork training in a paediatric emergency department (ED). Methods: Multidisciplinary healthcare providers responded to critical simulated patients in an urban ED during all sh...
Article
Given the growing interest in understanding and improving handovers, a deeper understanding of exactly how to create the most effective handover is necessary. This unique symposium will emphasize the distinction between salience and comprehensiveness in handover communications across multiple acute care settings. The discussion panel brings togethe...
Article
Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focus...
Article
Clinical work is accomplished by complex, highly distributed, joint cognitive systems, and involves high levels of uncertainty and ambiguity. Hospital emergency departments (EDs) in particular must adapt to uncertainty, ambiguity and change on a variety of different temporal scales. Many of these adaptations are unofficial, in part because they can...
Article
Full-text available
The JAMIA article entitled, ‘Failure to utilize functions of an electronic prescribing system and the subsequent generation of ‘technically preventable’ computerized alerts,’ by Baysari et al 1 identifies an intriguing phenomenon that may contribute to alert fatigue. For this study, an audit of electronic inpatient medication charts was conducted a...
Article
Full-text available
Article
The discipline of ergonomics, or human factors engineering, has made substantial contributions to both the development of a science of safety, and to the improvement of safety in a wide variety of hazardous industries, including nuclear power, aviation, shipping, energy extraction and refining, military operations, and finance. It is notable that h...
Article
Health information technology (HIT) is widely believed to be an essential modality for improving the efficiency, effectiveness, and safety of healthcare, and has its adoption has been vigorously promoted. However, the safety of commercially available HIT systems has never been independently and rigorously assessed. This paper discusses critical iss...
Article
ACADEMIC EMERGENCY MEDICINE 2011; 18:1283–1288 © 2011 by the Society for Academic Emergency Medicine This article describes the results of the Interventions to Safeguard Safety breakout session of the 2011 Academic Emergency Medicine (AEM) consensus conference entitled “Interventions to Assure Quality in the Crowded Emergency Department.” Using a m...
Article
Full-text available
Like other high hazard sectors, successful crisis response relies on a well-founded understanding of the work domain and the manner in which operators perceive and deal with obstacles to achieving goals. That understanding is essential to the development of information and communications technology (ICT) that are intended to support operator perfor...
Article
Within the last decade, there has been a growing emphasis on applying human factors principles in the healthcare domain, and although human factors is a well-established scientific discipline, it is still a relatively new concept for the healthcare community. Educating healthcare audiences on the goals, history, and contributions of the human facto...
Article
Given the rising costs of health care, the current focus on improving patient safety, and the goals of reducing barriers to efficient healthcare access, there is a strong and rapid push towards the implementation of health information systems in a variety of health care contexts. This panel brings together individuals with experiences spanning huma...
Article
Information technology is rapidly being developed and implemented for health care environments, often as a replacement for paper based or other manual tools. One example of this transition is the replacement of large dry-erase boards, used in emergency departments (ED) for tracking patient locations and clinical care, with computerized patient-trac...
Article
ACADEMIC EMERGENCY MEDICINE 2011; 18:e45–e51 © 2011 by the Society for Academic Emergency Medicine With the 2010 federal health care reform passage, a renewed focus has emerged for the integration of electronic health records (EHRs) into the U.S. health care system. A consensus conference in October 2009 met to discuss the future research agenda wi...
Article
We were excited to see a study by Cahan et al1 reporting on “human factors” curriculum for surgical clerkship students in the December 2010 issue of the Archives of Surgery. Human factors research is underutilized in health care and has tremendous potential benefit to improve health care systems and patient safety. However, the human factors curric...
Article
We determine whether pharmacologic neuromuscular blockade with succinylcholine or rocuronium during emergency rapid sequence intubation affects pupillary response to light. This was a prospective case series of patients undergoing rapid sequence intubation between February 2008 and February 2009. Two blinded, independent emergency physicians assess...