Petrosoniak Andrew, Almeida Rodrigo, Pozzobon Laura Danielle, Hicks Christopher, Fan Mark, White Kari, McGowan Melissa, Trbovich Patricia
Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Simul Technol Enhanc Learn. 2018 Mar 16;5(2):78-84. doi: 10.1136/bmjstel-2017-000300. eCollection 2019.
Clinician movement and workflow analysis provides an opportunity to identify inefficiencies during trauma resuscitation care. Inefficient workflows may represent latent safety threats (LSTs), defined as unrecognised system-based elements that can negatively impact patients. In situ simulation (ISS) can be used to model resuscitation workflows without direct impact on patients. We report the pilot application of a novel, tracing tool to track clinician movement during high-fidelity ISS trauma sessions.
Twelve unannounced ISSs were conducted. An open source, Windows-based video overlay tracing tool was developed to generate a visual representation of participant movement during ISS. This tracing tool used a manual mouse tracking algorithm to produce point-by-point location information of a selected participant in a video. The tracing tool was applied to video recordings of clinicians performing a cricothyroidotomy during ISS trauma scenarios. A comparative workflow and movement analysis was completed, which included distance travelled and space utilisation. This data was visually represented with time-lapsed movement videos and heat maps.
A fourfold difference in the relative distance travelled was observed between participants who performed a cricothyroidotomy during an ISS trauma resuscitation. Variation in each participant's movement was attributable to three factors: (1) team role assignment and task allocation; (2) knowledge of clinical space: equipment location and path to equipment retrieval; and (3) equipment bundling. This tool facilitated LST identification related to cricothyroidotomy performance.
This novel tracing tool effectively generated a visual representation of participants' workflows and quantified movement during ISS video review. An improved understanding of human movement during ISS trauma resuscitations provides a unique opportunity to augment simulation debriefing, conduct human factor analysis of system elements (eg, tools/technology, physical environment/layout) and foster change management towards efficient workflows.
临床医生的活动和工作流程分析为识别创伤复苏护理过程中的低效环节提供了契机。低效的工作流程可能代表潜在安全威胁（LSTs），即未被识别的、可能对患者产生负面影响的基于系统的因素。现场模拟（ISS）可用于模拟复苏工作流程，而不会对患者产生直接影响。我们报告了一种新型追踪工具在高保真ISS创伤模拟过程中追踪临床医生活动的试点应用情况。
进行了12次不预先通知的ISS。开发了一种基于Windows的开源视频叠加追踪工具，以生成ISS期间参与者活动的可视化表示。该追踪工具使用手动鼠标追踪算法来生成视频中选定参与者的逐点位置信息。该追踪工具应用于临床医生在ISS创伤场景中进行环甲膜切开术的视频记录。完成了一项对比工作流程和活动分析，包括行进距离和空间利用情况。这些数据通过延时活动视频和热图进行可视化呈现。
在ISS创伤复苏过程中进行环甲膜切开术的参与者之间，观察到相对行进距离存在四倍差异。每个参与者活动的差异可归因于三个因素：（1）团队角色分配和任务安排；（2）临床空间知识：设备位置和获取设备的路径；（3）设备捆绑。该工具有助于识别与环甲膜切开术操作相关的潜在安全威胁。
这种新型追踪工具在ISS视频回顾期间有效地生成了参与者工作流程的可视化表示并量化了活动情况。对ISS创伤复苏期间人体活动的更好理解为加强模拟汇报、对系统要素（如工具/技术、物理环境/布局）进行人为因素分析以及推动向高效工作流程的变革管理提供了独特机会。
