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Topic Name: Proper Design of Patient Tracking Tools May Have Unintended Consequences
Category: Design technologies
Research persons: Ann Bisantz, Ph.D.
Location: University at Buffalo, United States
Details
Proper design of computational tools is critical if they are to be used with
success in patient-care settings, particularly in hospital emergency rooms, a
field study conducted by researchers at the University
at Buffalo and other institutions recently revealed.
Nationwide, electronic patient tracking technologies are replacing
traditional, dry-erase patient status boards, according to the UB researchers,
who conducted the study with colleagues at the University
of Rochester and the University of Florida,
Jacksonville.
The results were presented last month by the UB researchers at the annual
meeting of the Human Factors and Ergonomics Society.
The researchers studied how new electronic patient-status boards were
functioning in the emergency departments of two busy, university-affiliated
hospitals.
Overall, the UB researchers found that the computational tracking systems
tended to affect how health-care providers communicate information and track
activities regarding patient care, which can cause providers to change the way
they work.
The results provide an important case study of what can happen when new
technologies are developed without sufficient understanding by designers of the
nature of the work in which they will be used, according to Ann Bisantz, Ph.D.,
associate professor of industrial and systems engineering in the UB School of
Engineering and Applied Sciences, and a co-investigator on the study.
"Research in human factors, the study of the interactions between humans
and technology, has shown that in complex workplaces where safety is critical,
such mismatches between the way practitioners work and the technologies that are
supposed to support them can have unintended consequences, including
inefficiencies and workarounds, where the technology demands that people change
their work method," said Bisantz.
She noted that there were surface similarities between the manual
patient-status whiteboards that emergency departments have traditionally used
and the electronic ones that were installed.
But in observations, focus groups and interviews with nurses, physicians,
secretaries, IT specialists and administrators, the UB researchers learned that
the computerized systems were not designed to match all of the underlying
functionality of the manual boards.
According to Bisantz, manual whiteboards perform a critical, central function
for emergency departments, providing not just patient names and demographic
information, but also a means for health-care workers to share information on
patient complaints, vital signs, lab tests, consultations, dietary and allergy
alerts, and notices about patient rooms that need to be cleaned.
The results revealed that the innate flexibility of the manual whiteboard
allowed health-care providers and other emergency department staff to use it to
communicate with one another.
"The manual whiteboard allows flexibility in tracking patients,"
Bisantz said. "For example, maybe the first time the provider sees a
patient, she initials the name on the whiteboard, then the next time she circles
the initials, then when the patient is discharged, she might put an
"x" in the circle, signals that are a means of communicating with her
colleagues in the ER.
"With a computerized system, providers have to find an available
computer terminal and log-in," she said, noting: "The providers can't
just walk up to the whiteboard and make a notation."
In some cases, providers noted that computer systems hid some of the
information; if only three comments could be viewed per screen, they had to
click to get to another screen, requiring them to search for information that
might demand immediate attention.
The study also found that there were fewer visual cues with the computational
system. Some providers noted that they used to be able to get a sense of the
status of the emergency department just by walking through the room and visually
checking the manual whiteboard.
"Without that public display, providers have to sit down at the computer
and check it, which can add time or reduce awareness," said Bisantz.
Future modifications to computational tools for patient tracking may serve to
make such systems better correspond to user needs, Bisantz said, as long as such
modifications are based on user data, such as the information in this study.
"If you don't understand the underlying structure of the work that is
being done in a particular setting, then you cannot design the technology that
will best support it," Bisantz said.
Priyadarshini R. Pennathur, a doctoral candidate in the UB Department of
Industrial and Systems Engineering, was a co-author on the research. The work
was performed under a grant from the Emergency Medicine Foundation awarded to
Robert L. Wears, M.D., University of Florida, Jacksonville, a co-author on the
work. Other co-authors were Shawna J. Perry, M.D., University of Florida,
Jacksonville; Rollin J. Fairbanks, M.D., and Frank Zwemer, M.D., both of the
University of Rochester.
The UB researchers have now received funding from the Agency for Healthcare
Research and Quality of the U.S. Department of Health and Human Services to
develop simulations of proposed electronic patient tracking systems in order to
better evaluate and match them to the needs of hospital emergency departments.
In addition to Bisantz, co-investigators on that grant are Li Lin, Ph.D., UB
professor of industrial and systems engineering; Jennifer Brown, M.D., clinical
assistant professor of emergency medicine in the UB School of Medicine and
Biomedical Sciences and attending physician, Erie County Medical Center, as well
as collaborators at the University of Rochester and the University of Florida.
Note for Tracking system
In virtual space technology, a tracking system is generally a system capable of rendering virtual space to a human observer while tracking the observer's body coordinates. For instance, in dynamic virtual auditory space simulations, a real-time head tracker provides feedback to the central processor, allowing for selection of appropriate head-related transfer functions at the estimated current position of the observer relative to the environment.
About Researcher
Ann M. Bisantz,
Assistant Professor; Ph.D. Georgia Institute of Technology, 1997; Cognitive engineering, human-machine systems, human decision-making.
E-mail: bisantz@eng.buffalo.edu
The University at Buffalo is a premier research-intensive public university,
the largest and most comprehensive campus in the State University of New York.
UB's more than 28,000 students pursue their academic interests through more than
300 undergraduate, graduate and professional degree programs. Founded in 1846,
the University at Buffalo is a member of the Association of American
Universities.
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