Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Health Policy and Management, Bloomberg School of Public Health, School of Nursing; Institute for Clinical and Translational Research, Baltimore, Maryland, USA.
BMJ Qual Saf. 2021 Nov;30(11):893-900. doi: 10.1136/bmjqs-2020-011420. Epub 2021 Mar 10.
To compare the insulin infusion management of critically ill patients by nurses using either a common standard (ie, human completion of insulin infusion protocol steps) or smart agent (SA) system that integrates the electronic health record and infusion pump and automates insulin dose selection.
A within subjects design where participants completed 12 simulation scenarios, in 4 blocks of 3 scenarios each. Each block was performed with either the manual standard or the SA system. The initial starting condition was randomised to manual standard or SA and alternated thereafter.
A simulation-based human factors evaluation conducted at a large academic medical centre.
Twenty critical care nurses.
A systems engineering intervention, the SA, for insulin infusion management.
The primary study outcomes were error rates and task completion times. Secondary study outcomes were perceived workload, trust in automation and system usability, all measured with previously validated scales.
The SA system produced significantly fewer dose errors compared with manual calculation (17% (n=20) vs 0, p<0.001). Participants were significantly faster, completing the protocol using the SA system (p<0.001). Overall ratings of workload for the SA system were significantly lower than with the manual system (p<0.001). For trust ratings, there was a significant interaction between time (first or second exposure) and the system used, such that after their second exposure to the two systems, participants had significantly more trust in the SA system. Participants rated the usability of the SA system significantly higher than the manual system (p<0.001).
A systems engineering approach jointly optimised safety, efficiency and workload considerations.
比较护士使用常规标准（即人工完成胰岛素输注方案步骤）或智能代理（SA）系统对危重症患者进行胰岛素输注管理的效果，该系统整合了电子病历和输液泵，并实现了胰岛素剂量选择的自动化。
在一项基于参与者的研究中，参与者完成了 12 个模拟场景，分为 4 个 3 个场景的块。每个块都是使用手动标准或 SA 系统完成的。初始起始条件随机分配到手动标准或 SA，此后交替进行。
在大型学术医疗中心进行的基于模拟的人为因素评估。
20 名重症监护护士。
一种系统工程干预措施，即 SA，用于胰岛素输注管理。
主要研究结果是错误率和任务完成时间。次要研究结果是感知工作量、对自动化的信任和系统可用性，所有这些都使用以前验证过的量表进行测量。
与手动计算相比，SA 系统产生的剂量错误明显更少（17%（n=20）比 0，p<0.001）。使用 SA 系统，参与者的速度明显更快，完成方案（p<0.001）。SA 系统的总体工作负荷评分明显低于手动系统（p<0.001）。对于信任评分，存在时间（第一次或第二次暴露）和使用系统之间的显著交互作用，以至于在第二次接触这两个系统后，参与者对 SA 系统的信任度显著提高。参与者对 SA 系统的可用性评分明显高于手动系统（p<0.001）。
系统工程方法共同优化了安全性、效率和工作负荷的考虑因素。
