Dataset Information

Huddling for high reliability and situation awareness.

ABSTRACT: BACKGROUND:Studies show that implementing huddles in healthcare can improve a variety of outcomes. Yet little is known about the mechanisms through which huddles exert their effects. To help remedy this gap, our study objectives were to explore hospital administrator and frontline staff perspectives on the benefits and challenges of implementing a tiered huddle system; and propose a model based on our findings depicting the mediating pathways through which implementing a huddle system may reduce patient harm. METHODS:Using qualitative methods, we conducted semi-structured interviews and focus groups to obtain a deeper understanding of the huddle system and its outcomes as implemented in an academic tertiary care children's hospital with 539 inpatient beds. We recruited healthcare providers representing all levels using a snowball sampling technique (10 interviews), and emails, flyers, and paper invitations (six focus groups). We transcribed recordings and analysed the data using established techniques. RESULTS:Five themes emerged and provided the foundational constructs of our model. Specifically we propose that huddle implementation leads to improved efficiencies and quality of information sharing, increased levels of accountability, empowerment, and sense of community, which together create a culture of collaboration and collegiality that increases the staff's quality of collective awareness and enhanced capacity for eliminating patient harm. CONCLUSIONS:While each construct in the proposed model is itself a beneficial outcome of implementing huddles, conceptualising the pathways by which they may work allows us to design ways to evaluate other huddle implementation efforts designed to help reduce failures and eliminate patient harm.

SUBMITTER: Goldenhar LM

PROVIDER: S-EPMC6288816 | biostudies-other | 2013 Nov

REPOSITORIES: biostudies-other

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Huddling for high reliability and situation awareness.

Goldenhar Linda M LM Brady Patrick W PW Sutcliffe Kathleen M KM Muething Stephen E SE

BMJ quality & safety 20130606 11

<h4>Background</h4>Studies show that implementing huddles in healthcare can improve a variety of outcomes. Yet little is known about the mechanisms through which huddles exert their effects. To help remedy this gap, our study objectives were to explore hospital administrator and frontline staff perspectives on the benefits and challenges of implementing a tiered huddle system; and propose a model based on our findings depicting the mediating pathways through which implementing a huddle system ma ...[more]

PMID: 23744537

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Project description:We argue that providing cumulative risk as an estimate of the uncertainty in dynamically changing risky environments can help decision-makers meet mission-critical goals. Specifically, we constructed a simplified aviation-like weather decision-making task incorporating Next-Generation Radar (NEXRAD) images of convective weather. NEXRAD radar images provide information about geographically referenced precipitation. NEXRAD radar images are used by both pilots and laypeople to support decision-making about the level of risk posed by future weather-hazard movements. Using NEXRAD, people and professionals have to infer the uncertainty in the meteorological information to understand current hazards and extrapolate future conditions. Recent advancements in meteorology modeling afford the possibility of providing uncertainty information concerning hazardous weather for the current flight. Although there are systematic biases that plague people's use of uncertainty information, there is evidence that presenting forecast uncertainty can improve weather-related decision-making. The current study augments NEXRAD by providing flight-path risk, referred to as the Risk Situational Awareness Tool (RSAT). RSAT provides the probability that a route will come within 20 NMI radius (FAA recommended safety distance) of hazardous weather within the next 45 min of flight. The study evaluates four NEXRAD displays integrated with RSAT, providing varying levels of support. The "no" support condition has no RSAT (the NEXRAD only condition). The "baseline" support condition employs an RSAT whose accuracy is consistent with current capability in meteorological modeling. The "moderate" support condition applies an RSAT whose accuracy is likely at the top of what is achievable in meteorology in the near future. The "high" support condition provides a level of support that is likely unachievable in an aviation weather decision-making context without considerable technological innovation. The results indicate that the operators relied on the RSAT and improved their performance as a consequence. We discuss the implications of the findings for the safe introduction of probabilistic tools in future general aviation cockpits and other dynamic decision-making contexts. Moreover, we discuss how the results contribute to research in the fields of dynamic risk and uncertainty, risk situation awareness, cumulative risk, and risk communication.

Project description:BACKGROUND:The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise. METHODS:Two groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load. RESULTS:No statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362). CONCLUSIONS:This study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations.

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Huddling for high reliability and situation awareness.

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Huddling for high reliability and situation awareness.

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