Dzisko M, Lewandowska A, Wudarska B. Sensors (Basel). 2022;22:3536.
Interruptions and distractions in healthcare settings can inhibit safe care. This simulation study found that medical staff reaction time to changes in vital signs during stressful situations (telephone ringing, ambulance signal) was significantly slower than during non-stressful situations, which may increase the likelihood of medical errors.
Boquet A, Cohen T, Diljohn F, et al. J Patient Saf. 2021;17:e534-e539.
This study classified flow disruptions affecting the anesthesia team during cardiothoracic surgeries. Disruptions were classified into one of six human factors categories: communication, coordination, equipment issues, interruptions, layout, and usability. Interruptions accounted for nearly 40% of disruptions (e.g., events related to alerts, distractions, searching activity, spilling/dropping, teaching moment).
Joseph A, Khoshkenar A, Taaffe KM, et al. BMJ Qual Saf. 2019;28:276-283.
This direct observation study found that minor disruptions in usual workflow can combine to lead to an adverse event. More than half of the observed disruptions were related to the physical layout of the operating room, suggesting that physical design of operating rooms may affect surgical safety.
Medford-Davis LN, Singh H, Mahajan P. Pediatr Clin North Am. 2018;65:1097-1105.
The busy and complex emergency department environment harbors pressures can that hinder diagnostic safety. This review discusses the characteristics of emergency medicine that contribute to overreliance on heuristics and susceptibility to bias in decision making. The authors highlight the need to better monitor diagnostic error in the emergency department to inform the design of improvement activities. A previous WebM&M commentary discussed diagnostic delay in the emergency department.
Allan SH, Doyle PA, Sapirstein A, et al. Jt Comm J Qual Patient Saf. 2017;43:62-70.
Reducing the number of alarms can help alleviate alarm fatigue and the associated patient safety hazards. In this study, researchers successfully implemented a number of interventions which led to a 61% decrease in average alarms per monitored bed in a cardiovascular surgical intensive care unit and a reduction in cardiorespiratory events.
Skaugset M, Farrell S, Carney M, et al. Ann Emerg Med. 2016;68:189-95.
Interruptions and task-switching are common contributors to complexity in emergency care. Exploring behaviors associated with multitasking in various disciplines, including human factors engineering, cognition science, and business, this review outlines a framework for enhancing understanding of multitasking, such as whether it can be performed successfully and types of actions that can be combined safely.
Interruptions are a known safety hazard that occur frequently. This systematic review proposes that interruptions be considered a process with various potential consequences for multiple actors rather than single events and suggests a human factors approach to addressing interruptions.
Errors in surgical care are often associated with human factors, interruptions, and staffing issues. This commentary describes a program to augment safety in ambulatory surgery centers, which includes a surgical checklist, change management, and teamwork.
Marquard JL, Henneman PL, He Z, et al. J Exp Psychol Appl. 2011;17:247-56.
Medication administration errors are a common problem and have been linked to interruptions during nursing workflow. This study used behavioral psychology techniques to analyze how nurses' bedside behaviors influenced their ability to prevent medication administration errors.
Broom MA, Capek AL, Carachi P, et al. Anaesthesia. 2011;66:175-179.
The sterile cockpit rule mandates elimination of nonessential activities during aircraft takeoffs and landings. This study found disturbingly frequent interruptions during analogous phases of anesthesia management, demonstrating the need to develop a similar rule for the operating room.
Henneman EA, Gawlinski A, Blank FS, et al. Am J Crit Care. 2010;19:500-9.
Critical care nurses use a variety of methods to ensure patient safety, often relying upon their knowledge of the patient and personal relationships with other nurses and staff to identify and prevent errors.
Westbrook JI, Woods A, Rob MI, et al. Arch Intern Med. 2010;170:683-690.
Interruptions in nursing activities are a known patient safety concern, particularly around medication administration. Most studies describing this relationship are based on self-reported experiences, surveys, or retrospective analysis of voluntary reports. This study directly observed nurses during medication administration and discovered that each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors. Interruptions occurred in more than 50% of administrations with error severity increasing with interruption frequency. An alarming finding was that administration without interruptions still generated a procedural failure rate of nearly 70% and a clinical error rate of 25%. The latter findings are discussed further in an invited commentary [see link below] that advocates for greater efforts to improve the medication administration process, including protected times for these activities.
France DJ, Throop P, Walczyk B, et al. J Patient Saf. 2008;1:145-153.
This study evaluated the impact of a newly designed children's hospital on patient safety and job function. The investigators begin with a detailed discussion of the contextual factors involved in their hospital redesign, drawing on human factors approaches in safety interventions. They follow by presenting their hospital design process, sharing both unit and floor layouts aimed to ensure family-centered ideals. Results from the 270 clinical faculty and staff surveys suggested that the majority reported a better overall new facility, more efficient information and patient flow, and high ratings for work environment factors such as lighting and equipment availability. However, providers in intensive care settings expressed concern about the negative impact new designs played in team communications, rates of interruptions, and work processes. As perhaps expected, the findings demonstrated many benefits and some unanticipated consequences of the redesign efforts but ultimately reinforced the need for human factors expertise.
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