Ergonomics in Healthcare Delivery

Transcription

1 Ergonomics in Healthcare Delivery Pascale Carayon, Ph.D. Center for Quality and Productivity Improvement Department of Industrial and Systems Engineering University of Wisconsin-Madison / tel: of 20 June 15-16, 2006 Healthcare Systems Engineering Workshop

2 2 of 20 HSE at University of Wisconsin-Madison! CHESS: " Computer support system! CHSRA: " Measurement of quality in long-term care! CQPI/SEIPS: " Human factors engineering and systems engineering in patient safety! Two ISyE faculty are IOM members.! AHRQ training grant (with Population Health Sciences)! Graduate certificate in patient safety! Interdisciplinary HSE courses (pharmacy, population health sciences, medical physics)! Mentoring of physicians

3 Ergonomics in Healthcare Delivery Research needs! Major issues facing health care and patient safety: "Workload of healthcare providers "Medical errors and adverse events: identification, management, review, recovery "Reliability of systems, processes and technologies "Patient safety in a variety of settings "Transitions of care "Medical devices and healthcare information technology 3 of 20

4 - Work system and patient safety - SEIPS model (Carayon et al., 2003) Bar Coding Medication Administration Smart IV Pump CPOE EHR 4 of 20 SEIPS = Systems Engineering Initiative for Patient Safety

5 Task sequences observed BCMA medication istration START 1 obtain meds scan self 2 scan self enter pt room obtain meds 3 check med vs device scan self check med vs device scan med 4 scan med enter pt room check med vs device scan med double check enter pt room check med vs device enter pt room 5 enter pt room scan pt ID band scan med enter pt room double check by RN scan pt ID band scan med enter pt room scan med enter pt room scan pt ID band scan pt ID band A(1) B(1) scan pt ID band give med to pt C(2) D(22) scan pt ID band E (1) F (17) to patient G(1) scan pt ID band H(2) I(1) enter pt room scan pt ID band enter pt room L (1) scan pt ID band M (1) scan pt ID band N (1) scan pt ID band O (1) scan pt ID band P (1) Q(1) R (1) J(1) K(2) 5 of 20 02/04/2006

6 Work system factors observed in BCMA medication istration Technology and Tools Tasks Person Organization Environment! Tasks: "Potentially unsafe med..! Person: "Patient in isolation! Environment: "Messy, insufficient light! Technology: "Automation surprises, malfunctions! Organization: "interruptions 6 of 20

7 - Work system and patient safety - SEIPS model (Carayon et al., 2003) Outpatient surgery 7 of 20 SEIPS = Systems Engineering Initiative for Patient Safety

8 8 of 20 Outpatient surgery - Preoperative process

9 9 of 20 Patient shadowing

10 - Work system and patient safety - SEIPS model (Carayon et al., 2003) Inpatient care Pediatric hospital Outpatient surgery Primary care Intensive care Medication safety Infection control Quality of care Perceived quality/safety of care 10 of 20 SEIPS = Systems Engineering Initiative for Patient Safety

11 Study of ICU nurses! 298 nurses from 17 ICUs of 7 hospitals located in Wisconsin! Data collection between February and August 2004! ICUs with different specialties (trauma, medical, surgical, cardiac, cardiothoracic, neurosurgery, burn, pediatric, neonatal)! Overall response rate: 77% (ranging from 40% to 100%) 11 of 20

12 Technology and Tools Organization 298 ICU nurses 7 Wisconsin hospitals Performance obstacles at end of shift Person Tasks Environment delay seeing new orders 60 noise distractions family many calls from families searching pt charts searching supplies hectic work envt crowded work envt delay meds pharmacy inadequate workspace family needs pt rooms not well-stocked equipment unavailable teaching families 12 of 20

13 Lucian Leape in Ergonomics in Design Summer 2004! Given the complexity of health care and the formidable obstacles it presents to change, to overcome those barriers and create a safe culture does indeed seem to be the ultimate challenge for those who specialize in human factors. 13 of 20

14 Human Factors and Ergonomics IEA [International Ergonomics Association] definition ( "Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human wellbeing and overall system performance. Physical ergonomics Cognitive ergonomics Organizational ergonomics 14 of 20

15 Ergonomics expertise in healthcare organizations Employee health: occupational safety & health, ergonomics Purchasing of equipment: usability Quality improvement: process analysis Risk management: incident reporting, event analysis OR and critical care: teamwork, communication 15 of 20

16 Ergonomics in Healthcare Delivery Research needs! Major issues facing health care and patient safety: "Workload of healthcare providers "Medical errors and adverse events: identification, management, review, recovery "Reliability of systems, processes and technologies "Patient safety in a variety of settings "Transitions of care "Medical devices and healthcare information technology 16 of 20

17 What kind of ergonomics/hse research?!collaboration with healthcare researchers, professionals and organizations!remember the unique characteristics of healthcare: "Complexity "Criticality "People-intensiveness 17 of 20

18 Probably the first (modern) study on medication errors was conducted by Alphonse Chapanis (1960). 18 of 20

19 19 of 20

20 Need for ergonomics (intervention) research that will contribute to care that is: "safe "effective "patient-centered "timely "efficient "equitable 20 of 20