Greg Hallihan’s research while affiliated with University of Calgary and other places

Johanna Blaak, W21C, University of Calgary; Rachel DiMaio, University of Calgary; Julia Kupis, University of Calgary; Ross Sweetzir, Cisco Systems; Conny Betuzzi, Alberta Children’s Hospital, Alberta Health Services; Corey Dowler, Alberta Children’s Hospital, Alberta Health Services; Krista McIntytre, Alberta Children’s Hospital, Alberta Health Services; Jaime Kaufman, University of Calgary; Greg Hallihan, University of Calgary; John Conly, Foothills Medical Centre; Joseph Vayalumkal, Alberta Childrens Hospital Background: Interaction design offers a novel interventional strategy to enhance hand-hygiene compliance (HHC) and reduce hospital-acquired infections (HAIs) in the pediatric setting. A quality improvement initiative in collaboration with the University of Calgary and Alberta Health Services led to the implementation of a pilot project with sensor-embedded alcohol -based hand rub (ABHR) dispensers at a hematology-oncology and hematopoietic stem cell transplant unit at Alberta Children’s Hospital (ACH). Methods: Internet of things (IoT) sensors were installed in ABHR dispensers (n = 3) on the unit. Usage data were transmitted to a local server using an MQTT messaging protocol for 16 weeks. Real-time data visualization was presented on a central display next to the nursing station with 11 unique pediatric themes including dinosaurs, transportation, and Canadian animals. Data were collected with and without visualization, and frequency of use (FoU) was determined for both periods. Qualitative interviews with unit stakeholders (n = 13) were held to determine perceptions of the intervention. Results: During the first 8 weeks of the study period, the mean daily use without visualization was 47 times (SD, 14.5) versus 99 times (SD, 23.9) with visualization. When accounting for novelty, by removing the first week of data, the mean daily use was 92 (SD 19.6). The percentage increase from period 1 to period 2 was 96.6%, accounting for novelty. Qualitative interviews with stakeholders (n = 13) on the unit indicated that the intervention increased their personal awareness of hand hygiene (75%) and acted as a constant reminder to perform hand hygiene for everyone on the unit including nonclinical staff, patients, and family members (92%). Conclusions: These limited data suggest that interaction design may improve HH frequency and show promise as a tool for increased HH awareness and education. Interaction design provides a unique, innovative, and acceptable hand hygiene improvement strategy for staff, patients, and families in the pediatric inpatient setting. Funding: None Disclosures: None

The purpose of this study was to evaluate the safety and efficiency of a specific ambulance while providers delivered basic and advanced life support. Forty-eight, Emergency Medical Service (EMS) teams were observed delivering care to a simulated patient during an anaphylaxis scenario in a moving ambulance that contained a complete compliment of medical supplies and equipment. A detailed coding system was developed and applied to the audio and video behavioural data. Patterns of interaction among EMS personnel, the patient, equipment and the ambulance interior during the patient simulation scenario were analyzed. The results revealed a number of issues associated with the patient compartment including: potentially unsafe seated and standing positions; hazardous barriers to movement around the patient; difficulties accessing equipment and supplies; and the adequacy of work surfaces and waste disposal. A number of design recommendations are made to guide provider and patient comfort, efficiency and safety.

Pre-Hospital Emergency Medical Service work environments are complex, presenting unique challenges for the design of environments and equipment, digital technologies, and inter-organizational operational strategies. As researchers, our challenge is to understand how providers operate in these complex environments, especially during emergency situations, to ensure solutions to these challenges are well informed by representative evidence. This requires collecting data regarding human-system interactions occurring between many people with shifting roles, in dynamic and potentially dangerous environments, with complex patients and often acute time constraints. A lot is happening simultaneously, and our ability to learn and provide meaningful insights is challenged. In search for methods that will help us asses these situations we often use mixed methods that are adapted to the unique and changing conditions of each study. The goal of this session was to present Case Studies and methods used for the panelist’s research involving the emergency medical services work environment. We took a close look at the tools and methods employed by the panelists for their research, and learned about the benefits and limitations of their unique approaches, as they were implemented in unique contexts.

Central venous catheterization is a relatively common bedside medical procedure that involves the placement of a catheter into a patient»s internal jugular vein in order to administer medication or fluids. To learn this technique, medical students traditionally practice on training mannequins under the guidance of a clinical instructor. The objective of this project was to co-develop a standardized augmented reality solution for teaching medical students this procedure, which would enable them to practice independently and at their own pace. Following an iterative design and prototyping process, we compiled a comprehensive set of usability heuristics specific to augmented reality healthcare applications, used to identify unique usability issues associated with augmented reality software. This approach offers a better strategy to improve the usability of augmented reality system and increases the potential to standardize and render medical education more accessible. The benefits of applying augmented reality to simulated medical education come with heavy consequences in the event of poor learning outcomes. The usability of these systems is paramount to ensure the development of clinical competence is facilitated and not hindered.

We share lessons learned from a collaborative in situ simulation of Ebola preparedness for a large health region. The lessons are to use proactive analysis, undertake in situ simulation, and have professionals in infection prevention and control and those in human factors collaborate. These lessons are applicable as generalizable concepts, not only to Ebola preparedness but also to other infectious diseases, including the “next Ebola.” Implementing these concepts will help contribute to improvements in both patient and provider safety.

Point-of-care testing devices providing medically relevant information are increasingly used by members of the public without any formal medical knowledge. As a result, these devices may be used in extremely different contexts of use by users with different knowledge bases, whether that was the original designers’ intent or not. In this study, we first conducted out-of-the-box testing of a device for non-invasive blood hemoglobin measurement, for its potential for use by individuals with no healthcare-specific training. To do so, we photographed each step, condensing these into five higher-order categories, which we considered potential generic instructions for any point-of-care testing device. We then had individuals with no specific healthcare training test use of the device. We asked two groups of participants, one with Human Factors experience in healthcare and another with no Human Factors or healthcare specific training, to use the device and to list the steps they followed when using the device, keeping in mind if another individual was to follow the same steps to successfully use the device. The results from our study demonstrated that all users were able successfully complete the primary user task (i.e., to measure their hemoglobin) and to develop defined steps of device use. The latter were compared with a set of generic instructions developed by the study team. Our generic instructions may provide a standardized and generally applicable approach to using point-of-care testing devices.

The transmission of Ebola Virus (EV) to health care workers (HCW) has been documented in highly-resourced care settings, even with HCW use of personal protective equipment (PPE). This research describes an observational study involving simulated Ebola Virus Disease (EVD) patient scenarios in four tertiary acute care centers. Researchers recorded and analyzed audiovisual data to identify instances of potential HCW EV contamination. Video-analysis was based on a coding taxonomy developed in collaboration with Infection Prevention and Control (IPC) professionals. The analysis focused on events and actions associated with potential HCW contamination during doffing and PPE disposal, and contributing system factors. The events and actions identified included out-of-sync doffing teams, HCW deviations from doffing protocols, and improper disposal of doffed PPE including the compression of PPE in biomedical waste containers containing potentially contaminated sharps. These observations are discussed along with recommendations for the re-design of doffing procedural aids and waste disposal.