Experimental multi-element HFE intervention
| System feature | Specific deficiencies identified in baseline system implementation | Experimental intervention implemented | HFE basis for intervention |
|---|---|---|---|
| Physical/human-machine HFE (system hardware+accessibility) | |||
| Alarm system hardware (alarm audibility) | Alarm speakers muted or non-functional | • Repositioning of speakers to distributed telemetry display locations • Adjustment of alarm volumes for audible, less obtrusive notification | • Hardware assessment • Real-time observation • Simulation observation • End-user Web survey and discussions |
| Alarm system hardware (alarm visibility) | Telemetry displays located in peripheral areas (eg, hallways, spaces for ED interpreting services) | • Repositioning of central telemetry displays to physician stations • Installation of distributed telemetry large-screen displays at nurse stations (with reduced emphasis/reliance solely on audible alarms) | • Hardware assessment • Real-time observation • Simulation observation • End-user Web survey and discussions |
| System input interface | Traditional keyboard and mouse input devices missing, also suboptimal for limited workspace | • Placement of touchpad input devices at physician station telemetry displays and at nursing stations for intuitive interaction | • Hardware assessment • Usability assessment • End-user discussions |
| Cognitive/Human-Software HFE (System Informational Relevance+Utility) | |||
| Clinical relevance | Poor signal:noise ratio, with excessive false alarms (anticipatory and immediate)21 resulting in ‘alarm fatigue’ | • Alarm parameter adjustment to reduce false alarms, ie, ‘Red’ alarms only for: – Asystole >4 s – Bradycardia <40 bpm – Tachycardia >130 bpm – (VF) or (VT>100 bpm) ‘Yellow’ alarms for: – NSVT – R-on-T PVC – SVT >180 bpm – Ventricular rhythm >14 PVCs Additional vital sign alarms: – SBP >200 mm Hg – SBP <90 mm Hg – SpO2 <89% – Removal of all RR alarms (eg, apnoea) • Two-room CareGroup pairing | • Real-time observation • End-user Web survey and iterative discussions for participatory design • Institutional expert input+guidance with modified Delphi process |
| General utility | Low yield of system access for clinical providers | • System integration into nurse charting informational workflow | • End-user Web survey, discussions • RN observations |
| Organisational/human-organisation HFE (system maintenance+user base) | |||
| System maintenance | System PC components in disrepair (disconnected, physically distressed and/or non-booting PC's) | • Repositioning and updating of system PC components in separate, secluded spaces • Coordination of institutional infra-structure for routine maintenance | • Hardware assessment • Institutional expert input • 5S principles (sort, straighten, sweep, standardise, sustain) |
| User awareness | Widespread knowledge deficit of system presence, availability and features | • Announcement of study conduct and intervention at ED personnel meetings • Study simulation sessions | • Real-time observation • Simulation observation • End-user Web survey and discussions |
| User familiarity | Widespread knowledge deficit of system operation | • Group in-servicing and on-shift in-servicing of ED personnel | • Real-time observation • End-user discussions |
ED, emergency department; HFE, human factors engineering; NSVT, non-sustained ventricular tachycardia; PVC, premature ventricular contraction; RR, respiratory rate; SBP, systolic blood pressure; SpO2, oxygen saturation (pulse oximetry); SVT, supraventricular tachycardia; VF, ventricular fibrillation; VT, ventricular tachycardia.