Imaging equipment such as MRIs, CT scanners and general radiography equipment consume significant... more Imaging equipment such as MRIs, CT scanners and general radiography equipment consume significant amounts of energy while operating. This study describes a series of detailed energy consumption studies on these devices during clinical use at three major health care centres in Canada, one in British Columbia and two in Ontario. The study was conducted by the Canadian Coalition for Green Health Care [1], with funding provided by Natural Resources Canada [2] and BC Hydro [3]. The primary goal of the study was to accelerate the development of ENERGY STAR specifications for medical imaging equipment. Natural Resources Canada is assisting the United States Environmental Protection Agency (US EPA) [4], by collecting these data from the field. Eight testing events were undertaken, providing energy consumption data for low power energy modes, standby/idle power energy modes and active/patient scanning energy modes. Energy consumption was measured over periods ranging from three to eleven day...
Every year, tens of thousands of patients in North America die from preventable errors. Incident ... more Every year, tens of thousands of patients in North America die from preventable errors. Incident reporting and learning provide a means of decreasing this number, but due to several barriers, these systems are not currently reaching their full potential in health care. The goal of this study is to improve patient safety by designing strategies to advance incident learning in health care. A literature review was conducted to gather details about health care, aviation, and nuclear power incident learning systems. This information was used to identify areas for improvement in health care’s incident learning processes and extract potential strategies for improvement. The suggested strategies to be developed in this research could be followed by administrators who are making crucial decisions pertaining to the incident learning process. This should help create more effective systems, and in turn, improve patient safety.
BACKGROUND Administering multiple intravenous (IV) infusions to a single patient via infusion pum... more BACKGROUND Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. OBJECTIVES To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses' ability to safely administer them. DATA SOURCES AND REVIEW METHODS Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). RESULTS Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors)identifying IV infusions (e.g., 7.7% line-tracing errors)managing dead volume (e.g., 96.0% flus...
BACKGROUND Research conducted in earlier phases of this study prospectively identified a number o... more BACKGROUND Research conducted in earlier phases of this study prospectively identified a number of concerns related to the safe administration of multiple intravenous (IV) infusions in Ontario hospitals. OBJECTIVE To investigate the potential prevalence of practices or policies that may contribute to the patient safety risks identified in Phase 1b of this study. DATA SOURCES AND REVIEW METHODS Sixty-four survey responses were analyzed from clinical units where multiple IV infusions may occur (e.g., adult intensive care units). Survey questions were organized according to the topics identified in Phase 1b as potential contributors to patient harm (e.g., labelling practices, patient transfer practices, secondary infusion policies). RESULTS Survey results indicated suboptimal practices and policies in some clinical units, and variability in a number of infusion practices. Key areas of concern included the following: use of primary IV tubing without back check valves when administering ...
This paper describes the ways in which human factors methods can help to enhance the work of esta... more This paper describes the ways in which human factors methods can help to enhance the work of established clinical engineering teams by placing a new emphasis on error reduction and patient safety. This approach in many ways represents a natural evolution for departments that are looking to enhance their usefulness and relevance to healthcare. Several examples are given of points at which the introduction of human factors methods can reveal issues related to the safe use of medical devices that are not easily accessible by other means. Adoption and implementation of these methods offers the potential for clinical engineering departments to enhance their role of helping to ensure optimal patient safety.
BMC medical informatics and decision making, Dec 22, 2017
Little research has examined how physicians choose medical devices for treating individual patien... more Little research has examined how physicians choose medical devices for treating individual patients to reveal if interventions are needed to support decision-making and reduce device-associated morbidity and mortality. This study explored factors that influence choice of implantable device from among available options. A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites. They were asked how they decided what device to use in a given patient, sources of information they consulted, and how patients were engaged in decision-making. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team. Twenty-two physicians from five Canadian provinces (10 cardiovascular, 12 orthopedic; 8, 10 and 4 early, mid and late career, respectively) were interviewed. Res...
International Journal of Technology Assessment in Health Care
Objectives: Medical devices are ubiquitous in modern medical care. However, little is known about... more Objectives: Medical devices are ubiquitous in modern medical care. However, little is known about the epidemiology of medical devices in the healthcare marketplace, including the rate at which medical devices are subject to recalls or other advisories. We sought to study the epidemiology of medical devices in Canada, focusing on device recalls. In Canada, a recall may signify a variety of events, ranging from relatively minor field safety notifications, to removal of a product from the marketplace. Methods: We used data from Health Canada to study medical device recalls in Canada from 2005 to 2015. We analyzed the risks of medical device recalls according to the risk class of the device (I lowest; IV highest) and the hazard priority of the recall (Type I highest potential harm; Type III lowest potential harm). Results: During a 10-year period, there were 7,226 medical device recalls. Most recalls were for intermediate risk class (Class II, 40.1 percent; Class III, 38.7 percent) medi...
Postmarket surveillance of medical devices is reliant on physician reporting of adverse medical d... more Postmarket surveillance of medical devices is reliant on physician reporting of adverse medical device events (AMDEs). Little is known about factors that influence whether and how physicians report AMDEs, an essential step in developing behaviour change interventions. This study explored factors that influence AMDE reporting. Qualitative interviews were conducted with physicians who differed by specialties that implant cardiovascular and orthopaedic devices prone to AMDEs, geography and years in practice. Participants were asked if and how they reported AMDEs, and the influencing factors. Themes were identified inductively using constant comparative technique, and reviewed and discussed by the research team on four occasions. Twenty-two physicians of varying specialty, region, organisation and career stage perceived AMDE reporting as unnecessary, not possible or futile due to multiple factors. Physicians viewed AMDEs as an expected part of practice that they could manage by switchin...
International journal for quality in health care : journal of the International Society for Quality in Health Care, Jan 13, 2017
Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the c... more Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions. Qualitative interviews using a basic descriptive approach. Canada. Practicing cardiovascular and orthopaedic physicians. Level, processes and determinants of PE in medical device discussions and decisions. Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device ...
The infusion of contrast solution into multiple patients from a single infusion bag is desired in... more The infusion of contrast solution into multiple patients from a single infusion bag is desired in clinics concerned with the high cost of the solution. Using one-way check valves in the infusion line is a protection method to reduce the risk of blood-borne cross-contamination. The suitability of this method is assessed through testing of the operating characteristics of the valves and infusion system and the high back pressure testing of the valves. The results indicate that the use of back-flow valves can ensure the prevention of flow from the patient to the injector. Results also indicate that the use of sprung valves, those which require a significant forward pressure to open them, are more appropriate for this application.
ABSTRACT This paper describes the development and impact of a team of 12 clinical engineers, huma... more ABSTRACT This paper describes the development and impact of a team of 12 clinical engineers, human factors engineers and cognitive psychologists based in a healthcare setting dedicated to the examination of healthcare technologies, processes, and environments from a human factors perspective. The motivation for this work came from a growing realization that errors in healthcare often result from the use of technologies and processes that are poorly designed and implemented for clinical use. A human factors approach to the assessment of existing technologies and processes, and to the design of new healthcare products, helps to uncover systemic flaws that can lead to errors in healthcare delivery. The Healthcare Human Factors group works on local, national and international studies that are designed to uncover intrinsic weaknesses in the design and implementation of a wide range of technologies used in healthcare, from medical devices and healthcare IT applications to complex clinical workflows. Utilizing the simulation labs at the Centre for Global eHealth Innovation, structured assessments and experiments in both clinical settings and in our usability labs, which can be configured to replicate a wide variety of complex clinical environments, are conducted. This work is supported by peer-reviewed grants, healthcare facilities, government agencies and commercial manufacturers of healthcare technologies. This paper provides an overview of the accomplishments of the group and presents key findings, which have significance for the improvement of patient safety. KeywordsSafety-healthcare-human factors-usability
Assess the impact of infusion pump technologies (traditional pump vs smart pump vs smart pump wit... more Assess the impact of infusion pump technologies (traditional pump vs smart pump vs smart pump with barcode) on nurses' ability to safely administer intravenous medications. Experimental study with a repeated measures design. High-fidelity simulated inpatient unit. The nurses remedied 60% of "wrong drug" errors. This rate did not vary as a function of pump type. The nurses remedied "wrong patient" errors more often when using the barcode pump (88%) than when using the traditional pump (46%) or the smart pump (58%) (Cochran Q=14.36; p<0.05). The number of nurses who remedied "wrong dose hard limit" errors was higher when using the smart pump (75%) and the barcode pump (79%) than when using the traditional pump (38%) (Cochran Q=12.13; p<0.003). Conversely, there was no difference in remediation of "wrong dose soft limit" errors across pump types. The nurses' pump programming was less accurate when mathematical conversions were requi...
Imaging equipment such as MRIs, CT scanners and general radiography equipment consume significant... more Imaging equipment such as MRIs, CT scanners and general radiography equipment consume significant amounts of energy while operating. This study describes a series of detailed energy consumption studies on these devices during clinical use at three major health care centres in Canada, one in British Columbia and two in Ontario. The study was conducted by the Canadian Coalition for Green Health Care [1], with funding provided by Natural Resources Canada [2] and BC Hydro [3]. The primary goal of the study was to accelerate the development of ENERGY STAR specifications for medical imaging equipment. Natural Resources Canada is assisting the United States Environmental Protection Agency (US EPA) [4], by collecting these data from the field. Eight testing events were undertaken, providing energy consumption data for low power energy modes, standby/idle power energy modes and active/patient scanning energy modes. Energy consumption was measured over periods ranging from three to eleven day...
Every year, tens of thousands of patients in North America die from preventable errors. Incident ... more Every year, tens of thousands of patients in North America die from preventable errors. Incident reporting and learning provide a means of decreasing this number, but due to several barriers, these systems are not currently reaching their full potential in health care. The goal of this study is to improve patient safety by designing strategies to advance incident learning in health care. A literature review was conducted to gather details about health care, aviation, and nuclear power incident learning systems. This information was used to identify areas for improvement in health care’s incident learning processes and extract potential strategies for improvement. The suggested strategies to be developed in this research could be followed by administrators who are making crucial decisions pertaining to the incident learning process. This should help create more effective systems, and in turn, improve patient safety.
BACKGROUND Administering multiple intravenous (IV) infusions to a single patient via infusion pum... more BACKGROUND Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. OBJECTIVES To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses' ability to safely administer them. DATA SOURCES AND REVIEW METHODS Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). RESULTS Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors)identifying IV infusions (e.g., 7.7% line-tracing errors)managing dead volume (e.g., 96.0% flus...
BACKGROUND Research conducted in earlier phases of this study prospectively identified a number o... more BACKGROUND Research conducted in earlier phases of this study prospectively identified a number of concerns related to the safe administration of multiple intravenous (IV) infusions in Ontario hospitals. OBJECTIVE To investigate the potential prevalence of practices or policies that may contribute to the patient safety risks identified in Phase 1b of this study. DATA SOURCES AND REVIEW METHODS Sixty-four survey responses were analyzed from clinical units where multiple IV infusions may occur (e.g., adult intensive care units). Survey questions were organized according to the topics identified in Phase 1b as potential contributors to patient harm (e.g., labelling practices, patient transfer practices, secondary infusion policies). RESULTS Survey results indicated suboptimal practices and policies in some clinical units, and variability in a number of infusion practices. Key areas of concern included the following: use of primary IV tubing without back check valves when administering ...
This paper describes the ways in which human factors methods can help to enhance the work of esta... more This paper describes the ways in which human factors methods can help to enhance the work of established clinical engineering teams by placing a new emphasis on error reduction and patient safety. This approach in many ways represents a natural evolution for departments that are looking to enhance their usefulness and relevance to healthcare. Several examples are given of points at which the introduction of human factors methods can reveal issues related to the safe use of medical devices that are not easily accessible by other means. Adoption and implementation of these methods offers the potential for clinical engineering departments to enhance their role of helping to ensure optimal patient safety.
BMC medical informatics and decision making, Dec 22, 2017
Little research has examined how physicians choose medical devices for treating individual patien... more Little research has examined how physicians choose medical devices for treating individual patients to reveal if interventions are needed to support decision-making and reduce device-associated morbidity and mortality. This study explored factors that influence choice of implantable device from among available options. A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites. They were asked how they decided what device to use in a given patient, sources of information they consulted, and how patients were engaged in decision-making. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team. Twenty-two physicians from five Canadian provinces (10 cardiovascular, 12 orthopedic; 8, 10 and 4 early, mid and late career, respectively) were interviewed. Res...
International Journal of Technology Assessment in Health Care
Objectives: Medical devices are ubiquitous in modern medical care. However, little is known about... more Objectives: Medical devices are ubiquitous in modern medical care. However, little is known about the epidemiology of medical devices in the healthcare marketplace, including the rate at which medical devices are subject to recalls or other advisories. We sought to study the epidemiology of medical devices in Canada, focusing on device recalls. In Canada, a recall may signify a variety of events, ranging from relatively minor field safety notifications, to removal of a product from the marketplace. Methods: We used data from Health Canada to study medical device recalls in Canada from 2005 to 2015. We analyzed the risks of medical device recalls according to the risk class of the device (I lowest; IV highest) and the hazard priority of the recall (Type I highest potential harm; Type III lowest potential harm). Results: During a 10-year period, there were 7,226 medical device recalls. Most recalls were for intermediate risk class (Class II, 40.1 percent; Class III, 38.7 percent) medi...
Postmarket surveillance of medical devices is reliant on physician reporting of adverse medical d... more Postmarket surveillance of medical devices is reliant on physician reporting of adverse medical device events (AMDEs). Little is known about factors that influence whether and how physicians report AMDEs, an essential step in developing behaviour change interventions. This study explored factors that influence AMDE reporting. Qualitative interviews were conducted with physicians who differed by specialties that implant cardiovascular and orthopaedic devices prone to AMDEs, geography and years in practice. Participants were asked if and how they reported AMDEs, and the influencing factors. Themes were identified inductively using constant comparative technique, and reviewed and discussed by the research team on four occasions. Twenty-two physicians of varying specialty, region, organisation and career stage perceived AMDE reporting as unnecessary, not possible or futile due to multiple factors. Physicians viewed AMDEs as an expected part of practice that they could manage by switchin...
International journal for quality in health care : journal of the International Society for Quality in Health Care, Jan 13, 2017
Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the c... more Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions. Qualitative interviews using a basic descriptive approach. Canada. Practicing cardiovascular and orthopaedic physicians. Level, processes and determinants of PE in medical device discussions and decisions. Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device ...
The infusion of contrast solution into multiple patients from a single infusion bag is desired in... more The infusion of contrast solution into multiple patients from a single infusion bag is desired in clinics concerned with the high cost of the solution. Using one-way check valves in the infusion line is a protection method to reduce the risk of blood-borne cross-contamination. The suitability of this method is assessed through testing of the operating characteristics of the valves and infusion system and the high back pressure testing of the valves. The results indicate that the use of back-flow valves can ensure the prevention of flow from the patient to the injector. Results also indicate that the use of sprung valves, those which require a significant forward pressure to open them, are more appropriate for this application.
ABSTRACT This paper describes the development and impact of a team of 12 clinical engineers, huma... more ABSTRACT This paper describes the development and impact of a team of 12 clinical engineers, human factors engineers and cognitive psychologists based in a healthcare setting dedicated to the examination of healthcare technologies, processes, and environments from a human factors perspective. The motivation for this work came from a growing realization that errors in healthcare often result from the use of technologies and processes that are poorly designed and implemented for clinical use. A human factors approach to the assessment of existing technologies and processes, and to the design of new healthcare products, helps to uncover systemic flaws that can lead to errors in healthcare delivery. The Healthcare Human Factors group works on local, national and international studies that are designed to uncover intrinsic weaknesses in the design and implementation of a wide range of technologies used in healthcare, from medical devices and healthcare IT applications to complex clinical workflows. Utilizing the simulation labs at the Centre for Global eHealth Innovation, structured assessments and experiments in both clinical settings and in our usability labs, which can be configured to replicate a wide variety of complex clinical environments, are conducted. This work is supported by peer-reviewed grants, healthcare facilities, government agencies and commercial manufacturers of healthcare technologies. This paper provides an overview of the accomplishments of the group and presents key findings, which have significance for the improvement of patient safety. KeywordsSafety-healthcare-human factors-usability
Assess the impact of infusion pump technologies (traditional pump vs smart pump vs smart pump wit... more Assess the impact of infusion pump technologies (traditional pump vs smart pump vs smart pump with barcode) on nurses' ability to safely administer intravenous medications. Experimental study with a repeated measures design. High-fidelity simulated inpatient unit. The nurses remedied 60% of "wrong drug" errors. This rate did not vary as a function of pump type. The nurses remedied "wrong patient" errors more often when using the barcode pump (88%) than when using the traditional pump (46%) or the smart pump (58%) (Cochran Q=14.36; p<0.05). The number of nurses who remedied "wrong dose hard limit" errors was higher when using the smart pump (75%) and the barcode pump (79%) than when using the traditional pump (38%) (Cochran Q=12.13; p<0.003). Conversely, there was no difference in remediation of "wrong dose soft limit" errors across pump types. The nurses' pump programming was less accurate when mathematical conversions were requi...
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Papers by Anthony Easty