Yan Xiao

• The University of Texas at Arlington

Driving is challenging for older adults, especially those with cognitive impairments. This paper systematically reviewed 39 peer-reviewed studies to examine the impact of cognitive deficits on older adults’ driving abilities, focusing on the discussion of neuropsychological assessments including Trail Making Tests, Useful Field of View, Maze Test,...

In this chapter, we highlight the key characteristics of collaborative teams in healthcare and identify a variety of healthcare teams that differ by varying degrees of shared objectives, clarity of role specifications, and interdependencies. We then review sociotechnical design requirements for teamwork in healthcare settings, ending with two case...

Pain, especially chronic pain, is a complicated and subjective experience, threatening global healthcare as one of the most severe health problems. Traditionally, pain is assessed by Visual Analog Scale to indicate the pain intensity by the patient’s self-report, causing them to become biased by various psychosocial factors. In this study, we perfo...

Objective To develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults. Design, settings and participants Measures were developed and evaluated in a multisite prospective observational study of older adults (≥65 ye...

Background Previous research and safety advocacy groups have proposed various behaviors for older adults to actively engage in medication safety. However, little is known about how older adults perceive the importance and reasonableness of these behaviors in ambulatory settings. Objective This study aimed to assess older adults’ perceptions of the...

Background Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with...

BACKGROUND Previous research and safety advocacy groups have proposed various behaviors for older adults to actively engage in medication safety. However, little is known about how older adults perceive the importance and reasonableness of these behaviors in ambulatory settings. OBJECTIVE This study aimed to assess older adults’ perceptions of the...

BACKGROUND Preventable patient harms from medications are significant threats to patient safety in ambulatory and community settings, especially among community-dwelling older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning basics of medication self-m...

Objectives Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients and caregivers. Community-dwelling older adults self-manage their medications with minimal healthcare professional supervision. Although organizations, such as the Food and...

Chronic pain patients lack at-home pain assessment and management tools. The existing chronic-pain mobile applications are either solely relying on self-report pain levels or restricted to formal clinical settings. Our app, abbreviated from an NSF-funded project entitled Novel Computational Methods for Continuous Objective Multimodal Pain Assessmen...

What happens when “frontline” workers are patients and family members performing health-related tasks? As more and more complex healthcare tasks are performed by patients and family members, and more emphasis is placed on patient- and family-centered care, strategies are needed to engage patients and family members in co-design “work systems” and p...

Background Our aim was to understand actions by primary care teams to improve medication safety. Methods This was a qualitative study using one-on-one, semistructured interviews with the questions guided by concepts from collaborative care and systems engineering models, and with references to the care of older adults. We interviewed 21 primary ca...

Background Engaging patients in health behaviors is critical for better outcomes, yet many patient partnership behaviors are not widely adopted. Behavioral economics–based interventions offer potential solutions, but it is challenging to assess the time and cost needed for different options. Crowdsourcing platforms can efficiently and rapidly asses...

Older adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals’ roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structure...

Primary care plays a vital role for individuals and families in accessing care, keeping well, and improving quality of life. However, the complexities and uncertainties in the primary care delivery system (e.g., patient no-shows/walk-ins, staffing shortage, COVID-19 pandemic) have brought significant challenges in its operations management, which c...

Community-dwelling older adults are vulnerable to medication safety-related harms. Prevention of medication-related harms in the outpatient setting starts with thorough and thoughtful medication reconciliation at each patient encounter. Comprehensive medication reconciliation is challenging for prescribers to provide in busy time-pressured practice...

Introduction Over 4 billion prescriptions are dispensed each year to patients in the United States, with the number of prescriptions continuing to increase. There is a growing recognition of pharmacists’ potential in improving medication safety in community settings, in collaboration with primary care providers (PCPs). However, the nature of collab...

BACKGROUND The principles of behavioral economics (BE) suggest that there are many potential ways to develop meaningful health care partnerships with patients. Crowdsourced experimental surveys may help efficiently assess the time and cost needed for different options. OBJECTIVE The goals of this study were (1) to assess the feasibility of using c...

Objectives: Care transitions pose a high risk of adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach. Methods: Hospital-based professionals from 4 hospitals were interviewed about ADE risks after hospital discharge among older adults. Concerns were extrac...

Purpose: To review the literature on medication safety in primary care in the electronic health record era. Methods: Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abst...

Optimization of pain assessment and treatment is an active area of research in healthcare. The purpose of this research is to create an objective pain intensity estimation system based on multimodal sensing signals through experimental studies. Twenty eight healthy subjects were recruited at Northeastern University. Nine physiological modalities we...

Obtaining an objective measurement of the pain level of a patient has always been challenging for health care providers. The most common method of pain assessment in the hospital setting is asking the patients’ verbal ratings, which is considered to be a subjective approach. In order to get an objective pain level of a patient, we propose measuring...

Community-dwelling multi-morbid older adults are a vulnerable population for medication safety-related threats. We interviewed a sample of these older adults recruited from local retirement communities and from primary care practices to learn their perceptions of barriers and enablers for their medication safety. The present study is part of the Pa...

Objective: Pain assessment is of great importance in both clinical research and patient care. Facial expression analysis is becoming a key part of pain detection because it is convenient, automatic, and real-time. The aim of this study is to present a cold pain intensity estimation experiment, investigate the importance of the spatial-temporal inf...

Deprescribing is the process of withdrawing or replacing medications to improve outcomes and reduce medication-associated risks. Deprescribing, though traditionally the domain of healthcare professionals, is now receiving attention from human factors experts. In turn, the deprescribing community is gaining an appreciation for human-centered design...

Medication safety during care transitions is a significant challenge, especially for older adults prescribed multiple medications. Using a systems approach to understand barriers to and strategies for safe medication management throughout high-risk periods of hospital-to-home transition is one important step in designing effective interventions. Fr...

Patients’ pain level of the patients is a fundamental factor for the patients’ anesthetics usage. To investigate the responses of electroencephalogram (EEG) to cold pressor pain in the frequency domain, twenty healthy subjects’ EEG signals were recorded during a cold pressor test. A band-pass filter and independent component analysis were used to p...

Background Extended daily computer use and overload of clinicians has been associated with a reported increase of prescription error. New mouse activity designs offer alternative strategies to potentially decrease drop-down menu selection error in computerized physician order entry (CPOE) prescription. Objective This study aimed to evaluate the us...

Cancer patients interact with clinicians who are distributed across locations and organizations. This makes it difficult to coordinate care and adds to the burden of cancer care delivery. Failures in care coordination can harm patients. The rapid growth in the number of cancer survivors and the increasing complexity of cancer care has kindled an in...

There are major gaps and barriers for patients and caregivers after hospital discharge to achieve safe medication use. Patients and caregivers are often not ready to take on the responsibility for medication management when transitioned from inpatient care. Current approaches tend to focus on adding isolated strategies. A system thinking can enable...

Our health care system uses sophisticated cancer therapies, treatment technologies and facilities, and has dedicated and talented cancer specialists. Effective use of these innovations requires coordination of many diffuse components. For example, transitions between steps of care involve multiple actors and institutions, with distinct sets of info...

In an attempt to understand human physiological signals when an individual is subjected to pain, we set up a tonic pain experiment in a laboratory setting. The subjects’ physiological signals were recorded, timestamped, and compared to an initial 30 second baseline measurement. Subjects were also asked to verbally state their level of pain based on...

This discussion panel will focus on solutions for mitigating the negative impact of interruptions in healthcare. Five human factors practitioners who work within healthcare systems will present solutions of mitigating the negative impact of interruptions on safety and quality with the acknowledgement that interruptions in and of themselves should n...

Objective: The aim of this study is to increase nurses' time for direct patient care and improve safety via a novel human factors framework for nursing worksystem improvement. Background: Time available for direct patient care influences outcomes, yet worksystem barriers prevent nurses adequate time at the bedside. Methods: A novel human facto...

The task of patient identification is performed many times each day by nurses and other members of the care team. Armbands are used for both direct verification and barcode scanning during patient identification. Armbands and information layout are critical to reducing patient identification errors and dangerous workarounds. We report the effort at...

The role of human factors expertise has been recognized in development or deployment of new, sophisticated, high-tech systems in healthcare organizations. By contrast, the panelists will use examples to contrast their experience in brining value of human factors expertise to healthcare through “low-tech” solutions or methods. Frontline providers fa...

We thank Dr. Dexter for his comments on our article [1] about interpreting odds ratios, and we agree with him about the value of relative risk information. As pointed by Dr. Dexter, odds ratios can be an overestimator of relative risk, even though levels of statistical significance remain the same [2]. Dr. Dexter is correct in that our paper provid...

In this chapter, we highlight the key characteristics of collaborative teams in healthcare and identify a variety of healthcare teams that differ by varying degrees of shared objectives, clarity of role specifications, and interdependencies. We then review sociotechnical design requirements for teamwork in healthcare settings, ending with two case...

Human factors research has suggested benefits of consistent teams yet no surgical team consistency measures have been established for teamwork improvement initiatives. Retrospective analysis was conducted of teams performing consecutive elective procedures of unilateral primary total knee and hip replacement between June 2008 and May 2010 at a larg...

Surgical team members are typically defined by professional roles. In many surgical teams, membership changes as staffing decisions are subject to considerations other than keeping surgical teams consistent. These considerations may include staffing patterns on the day of surgery and at the time of a surgical case. Teamwork skill training and safet...

Techniques for presenting patient data at the patient's bedside include receiving predetermined presentation style data that indicates a subset of fewer than all parameters available from an electronic medical records (EMR) system and a first arrangement on a display device of related parameters in the subset. Without human intervention, the most r...

Objective: The aim of this study was to develop a survey tool to assess electronic health record (EHR) implementation to guide improvement initiatives. Background: Survey tools are needed for ongoing improvement and have not been developed for aspects of EHR implementation. Methods: The Baylor EHR User Experience (UX) survey was developed to c...

Health information technology has become common in the care of patients with chronic diseases; however, there are few such applications employed in kidney disease. The aim of the study was to evaluate the use of a website providing disease-specific safety information by patients with predialysis chronic kidney disease. As part of the Safe Kidney Ca...

Safety and quality of health care depend on collaborative efforts of multiprofessional and multidisciplinary teams of care providers. Team research in aviation and the military has produced a wealth of knowledge in terms of concepts and intervention strategies to improve team performance. Research on collaborative work in health care in the past 20...

This session will focus on lessons learned when teaching human factors (HF) to those working in the frontline in healthcare. HF education may help frontline professionals to appreciate the perspective to consider strengths and limitations of humans, to design robust solutions to counteract human limitations, and to test systems to understand how hu...

This session will focus on lessons learned when developing solutions for real world problems in healthcare. Human factors (HF) practitioners bring unique knowledge, methods, and perspectives to work with clinicians to address numerous defects in the worksystem but require problem-solving skills that focus on solutions. The HF contribution may be in...

Poor usability is a threat to patient safety and linked to productivity loss, workflow disruption, user frustration, sub-optimal product use and system de-installations. Although usability is receiving more attention nationally and internationally, myths about usability persist. This editorial debunks five common myths about usability (1) usability...

Growing evidence reveals the importance of improving safety culture in efforts to eliminate health care-associated infections. This multisite, cross-sectional survey examined the association between professional role and health care experience on infection prevention safety culture at 5 hospitals. The findings suggest that frontline health care tec...

The session will focus on the solution side of human factors contribution into real world problems in healthcare. Five practitioners who work within systems will present real world challenges which were discovered by HF methods, or which have heavy HF implications, but wheredirect HF influence on design lead to the ultimate effective solution. The...

Formally trained human factors professionals are in increasing demand from medical device companies, health care systems, and electronic health record (EHR) vendors to ensure successful device design, EHR deployment, and overall usability and quality improvement initiatives. Most members of this panel have extensive experience working in the health...

Communication problems among health care personnel during critical clinical situations can jeopardize patient safety. SBAR, a structured-communication technique, has been adapted from aviation and the military as a strategy for clear communication based on a statement of the situation, background, assessment, and recommendations related to a critic...

Documentation processes are an indispensible part of patient care. Timely access to complete and accurate documentation is crucial to patient safety. However, there is no sufficient tool to help health care professionals effectively manage documentation processes. In this study, we developed an evaluation methodology, including a documentation matr...

A Web-based training course with embedded video clips for reducing central line-associated bloodstream infections (CLABSIs) was evaluated and shown to improve clinician knowledge and retention of knowledge over time. To our knowledge, this is the first study to evaluate Web-based CLABSI training as a stand-alone intervention.

To understand expert and team cognition of complex patients in the pediatric intensive care unit through the use of cognitive task analysis. Qualitative study with semistructured interviews. Academic medical center pediatric intensive care unit. Physicians, nurses, and nurse practitioners. None. Semistructured interviews were conducted with members...

Information technology has the potential to significantly improve communication and coordination in health care. However, current technologies frequently impede clinical communication. A major reason for this discrepancy is due to lack of consideration of how clinical communication and coordination of care occur, which requires studying “in the wil...

Data on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) guide therapy in severe traumatic brain injury (TBI), but current linear analytic methods are insufficiently sensitive and specific for prognosis in dynamic situations over time. We have developed algorithms incorporating continuous, automated, digital ICP and CPP monitoring...

This project tested the hypothesis that computer-aided decision support during the first 30 minutes of trauma resuscitation reduces management errors. Ours was a prospective, open, randomized, controlled interventional study that evaluated the effect of real-time, computer-prompted, evidence-based decision and action algorithms on error occurrence...

The use of pharmacy delivery robots in an institution's intensive care units was evaluated. In 2003, the University of Maryland Medical Center (UMMC) began a pilot program to determine the logistic capability and functional utility of robotic technology in the delivery of medications from satellite pharmacies to patient care units. Three satellite...

Calculation of integer heart rate variability (HRVi) permits monitoring over extended periods. We asked whether continuous monitoring of HRVi or integer pulse pressure (PP) variability (PPVi) could predict intracranial hypertension, defined as ICP >20 mm Hg, cerebral hypoperfusion, defined as CPP<60 mm Hg, mortality or functional outcome after seve...

To identify and characterise hazardous conditions in an Emergency Department (ED) using active surveillance. This study was conducted in an urban, academic, tertiary care medical centre ED with over 45,000 annual adult visits. Trained research assistants interviewed care givers at the discharge of a systematically sampled group of patient visits ac...

Clinical decision support systems and other health information technologies arc being implemented in healthcare organizations to enhance clinician performance by helping to overcome the limits of human cognition. In spite of gains achieved with these systems, significant problems remain, including unexpected complexity and sometimes harmful effects...

Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions. A literature review and a brainstorming session with 11 researchers from a vari...

Earlier, more accurate assessment of secondary brain injury is essential in management of patients with traumatic brain injury (TBI). We assessed the accuracy and utility of high-resolution automated intracranial pressure (ICP) and cerebral perfusion pressure (CPP) recording and their analysis in patients with severe TBI. ICP and CPP data for 30 se...

Disruptions to surgical workflow have been correlated with an increase in surgical errors and suboptimal outcomes in patient safety measures. Yet, our ability to quantify such threats to patient safety remains inadequate. Data are needed to gauge how the laparoscopic operating room work environment, where the visual and motor axes are no longer ali...

To accommodate frequent emergencies, interruptions, and delays, hospital staff continually make and coordinate changes to the surgery schedule. The technical and social aspects of coordination in surgical suites have been described by prior studies. This paper addresses an understudied aspect of coordination: the physical environment. Based on a fi...

Background: A growing body of evidence reveals the importance of evaluating and improving safety culture in efforts to eliminate healthcare-associated infections (HAI). However, little is known about the extent to which perceptions of personal behavior are associated with safety culture, infection prevention practices and knowledge. Under the Theor...

Cognitive artifacts are created and used to support task performance in many domains. These artifacts may be essential components designed into a process, they may have been created by users as work-arounds to system shortcomings, or they may be extensions to systems that add functionalities to meet evolving needs. Examination of cognitive artifact...

Multidisciplinary rounds in the critical care environment have demonstrated increased communication, a reduction in medical errors, a shorter hospital stay, and consequently, economic savings. We attempt to assess the cost of this intervention, and to review the time utilization of professionals participating in the process. We analyzed video-recor...

To understand staff acceptance of a remote video monitoring system for operating room (OR) coordination. Improved real-time remote visual access to OR may enhance situational awareness but also raises privacy concerns for patients and staff. Survey. A system was implemented in a six-room surgical suite to display OR monitoring video at an access re...

In response to inherent inadequacies in health information technologies, clinicians create their own tools for managing their information needs. Little is known about these clinician-designed information tools. With greater appreciation for why clinicians resort to these tools, health information technology designers can develop systems that better...

Patient flow in a trauma center can be improved by multidisciplinary discharge rounds (MDR), but the content and logistics of MDR discussions have not been well quantified for purposes of improvement and adoption. We characterized the discussion content and time spent during MDRs and measured success rates in implementing communicated plans. Bedsid...

Proficiency in placing infraclavicular subclavian venous catheters can be achieved through practice and repetition. But few data specifically document insertion technical errors, which mentors could teach novice operators to avoid. Surgical, medical, and anesthesia textbooks and procedural handbooks were reviewed. Subclavian catheter placement tech...

Safe and efficient surgical operations depend on a work environment larger than the individual operating room (OR) and on communications at different levels of the hospital organization. Extensive communication is needed before and during surgery to ensure that surgical rooms, equipment, and supplies; patients; surgeons; supporting personnel; and a...

Our team has studied the use of telemedicine to overcome obstacles to providing acute stroke care and expanding stroke education. We report a summary of our outcomes to provide evidence supporting greater development of stroke telehealth systems. Stroke telemedicine is audio-video communication (teleconferencing) between a stroke specialist and a r...

This paper presents an ongoing observational study to explore a "front-stage-back-stage" model of information processes during group discussions (multidiscipli-nary rounds) in the pediatric intensive care unit (PICU) of an academic medical center. Participants were observed to collaborate on "front-stage" processes of case presentation, discussion...

Routine clinical information systems now have the ability to gather large amounts of data that surgical managers can access to create a seamless and proactive approach to streamlining operations and minimizing delays. The challenge lies in aggregating and displaying these data in an easily accessible format that provides useful, timely information...

On the day of surgery, real-time information of both room occupancy and activities within the operating room (OR) is needed for management of staff, equipment, and unexpected events. A status display system showed color OR video with controllable image quality and showed times that patients entered and exited each OR (obtained automatically). The s...

Continuous recorded in-flight vital signs monitoring and life-saving interventions linked to outcomes may provide better understanding of pre-hospital triage, care management and patient responses during the 'golden hour' of trauma care. Evaluation of 157 patients' vital signs data collected from our statewide network has identified episodes of phy...

We present an observational tool to capture computer usage patterns during rounds to inform designs of information and communication technology to support clinical discourse during rounds. The tool captures choreography and logistics of information exchanges supported by clinical information systems during rounds. We developed the tool as part of a...

This article describes challenges in the design and development of a decision support system for trauma patient resuscitation that is used to encourage consistency and reduce error rates. The Trauma Reception and Resuscitation Project links real-time, computer-generated prompts from best practice algorithms via visual and auditory displays. Its fun...

An anesthesia department implemented scheduling of anesthetics outside of operating rooms (non-OR) by clerks and nurses from other departments using its hospital's enterprise-wide scheduling system. Observational studies chronicled the change over 2 yr as non-OR time was allocated by specialty, and nonanesthesia clerks and nurses scheduled anesthes...

We illustrate how audio-video data records can improve emergency medical care, using airway management to show how such video data may help to identify unsafe acts, accident precursors, and latent and systems failures and to evaluate performance. This was a retrospective analysis of videos of real patient resuscitation in a trauma center. Participa...

Highly reliable, efficient collaborative work relies on excellent communication. We seek to understand how a traditional whiteboard is used as a versatile information artifact to support communication in rapid-paced, highly dynamic collaborative work. The similar communicative demands of the trauma operating suite and an emergency department (ED) m...

Intensive care units are high risk settings where reliability of team performance is critical. We interviewed nurses and physicians to understand practices used to achieve resilience in intensive care. A central theme emerged surrounding the concept of transactive responsibility, in contrast to intuitive approaches in organizational design such as...

Highly skilled professionals in mission critical work domains communicate complicated, critical information, frequently under time pressure. For example, sustained operations require shift work, which results in hand-offs of responsibilities and need of information transfers. There is a growing interest to support their communications through advan...

Despite American College of Surgeons Committee on Trauma's criteria, little data exists about the variability of practices in both the composition of trauma teams and timing of specialist availability across trauma centers. The purpose of the study was to determine the availability of trauma team personnel in Level I and II trauma centers across th...

Coordinating activities in many settings can require people to manage conflict, potential and actual. Conflict arises from resource limitations, high-stakes consequences, uncertainty, goal conflict among stake- holders and hierarchical organizational structures. To understand coordination in such systems, we con- ducted a field study of management...

In any collaborative work settings, people naturally develop physical tools and associated work processes that support the management of the interdependencies in information, materials, and social needs. Field studies of management of operating rooms pointed out that collaborative work is supported by an infrastructure that is composed of mostly no...