Wooldridge Abigail, Carayon Pascale, Hoonakker Peter, Hose Bat-Zion, Ross Joshua, Kohler Jonathan E, Brazelton Thomas, Eithun Benjamin, Kelly Michelle M, Dean Shannon M, Rusy Deborah, Durojaiye Ashimiyu, Gurses Ayse P
Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA.
Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA.
Cogn Technol Work. 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0. Epub 2018 Aug 31.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e. safety in complex systems. We discuss three levels of awareness (individual, team and organizational) and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration and decision making. A challenge to team awareness is inadequate "non-technical" skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, by using process modeling or simulation.
在美国，创伤是儿童和青年致残和死亡的主要原因。虽然我们对住院儿童创伤护理的医学方面了解很多，但对住院护理所涉及的流程和角色却知之甚少。我们运用人因工程学（HFE）方法，结合访谈、档案文件和创伤登记数据，来描述医院内护理转接如何影响流程和团队复杂性。具体而言，我们确定了每个医院科室中直接参与患者护理的53个角色，并描述了医院科室之间总共3324次转接，以及儿科创伤患者从入院到出院所经历的69条独特路径。我们继续论证从消除复杂性转向应对复杂性，并提议支持三个层次的意识，以增强医疗保健中患者安全所需的恢复力和适应能力，即复杂系统中的安全性。我们讨论了三个层次的意识（个人、团队和组织），并描述了每个层次的挑战和潜在的社会技术解决方案。例如，个人意识面临的一个挑战是时间压力大。一个潜在的解决方案是对信息感知、整合和决策提供临床决策支持。团队意识面临的一个挑战是“非技术”技能不足，例如领导力、沟通能力、角色清晰度；模拟或其他形式的培训可以改善这些方面。这个过程的复杂、分布式特性对组织意识构成挑战；一个潜在的解决方案是通过使用流程建模或模拟，来培养对流程以及其中的角色和相互依存关系的认识。
