Second victims are practitioners involved in an incident that (potentially) harms or kills somebody else, and for which they feel personally responsible. Professional culture and the psychology of blame (and shame) influence how second victims are viewed and dealt with. This paper reviews the status of second victimhood in healthcare -both its symptomatology and organizational responses. Then it considers the problematic nature of "human error" in healthcare and sets this against the psychological backdrop of healthcare professions, seeking cultural-historical explanations in assumptions of actor autonomy and professional identity. It concludes by drawing links between the psychological resilience of the individual practitioners involved in an incident and the resilience of an organization's safety culture.

Vibrotactile displays have been trialled in a variety of cognitively demanding domains, including healthcare. Previous work suggests that vibrotactile displays can be used to inform clinicians of patient status, particularly when the displays are alarm-style alerts in surgical or critical care. The goal of the present study is to evaluate how well a common measure of patient well-being-pulse oximetry-can be communicated via an upper-arm vibrotactile prototype. Pulse oximetry includes two important vital signs: heart rate and oxygen saturation. Two displays were tested in a between-subjects design: (1) the Separated display presented heart rate first, followed by oxygen saturation; and (2) the Integrated display communicated both vital signs simultaneously. Participants identified five ranges of heart rate and three levels of oxygen saturation with very high accuracy (>90%), regardless of display type. Although participants' identification accuracy improved marginally with practice, their initial high level of performance was achieved with minimal training. Findings will inform a broader program of research in which we aim to test whether vibrotactile displays might be useful as a part of multi-modal patient monitoring.

Objectives: Interruptions occur frequently in the intensive care unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know whether interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. The aim of the study was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions. Methods:We conducted a prospective controlled trial in a high-fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepared and administered intravenous medications for a patient manikin. Nurses received either 3 (n = 35) or 12 (n = 35) scenario-relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinical errors and procedural failures committed by each nurse. Results:The rate ratio of clinical errors committed by nurses who received 12 interruptions compared with nurses who received 3 interruptions was 2.0 (95% confidence interval = 1.41-2.83, P < 0.001). The rate ratio of procedural failures committed by nurses who received 12 interruptions compared with nurses who were interrupted 3 times was 1.2 (95% confidence interval = 1.05-1.37, P = 0.006).Conclusions: More workplace interruptions during medication preparation and administration lead to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicate.

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Introduction:Some patients presenting to rural or regional hospitals may be deteriorating so rapidly that emergency procedures might be necessary before transfer to specialist facilities. Such interventions might include placement of an ICC, establishing a surgical airway, evacuation of an EDH, laparotomy, or intra-abdominal packing. The treating clinician may have had little or no experience in the procedure. Interactive telepresence technology offers further point of care support to the treating clinicians through the virtual presence of a specialist from a major trauma center.Aim:To explore the feasibility of wearable interactive telepresence technology that can provide sub-specialist support to remote clinicians treating patients with traumatic injuries.Methods:Thirty-seven wearable near-field display devices and annotation software applications were tested against a set of pre-specified technical and user experience requirements. A shortlist of three devices and two software applications underwent usability evaluations with a convenience sample of 24 junior clinicians and sub-specialists. The junior clinicians trialed the wearable devices and the sub-specialists trialed the annotation applications in three simulated trauma scenarios. Measures included participants’ ratings of acceptance and workload, technical issues encountered (e.g. frequency of call drop-outs), and anecdotal comments.Results:Participants’ subjective ratings of the solutions and anecdotal feedback were positive. However, there was no clear solution that satisfied the functionality and ease-of-use requirements for all participants. For example, the solutions that were rated more favorably by the junior clinicians were rated less favorably by the sub-specialists, and vice versa.Discussion:This work provided preliminary evidence of the feasibility and usefulness of interactive telepresence technology in healthcare. A second phase of usability testing is currently underway to explore additional device and software combinations, including those with augmented reality functionality. Future phases of the project will evaluate the solutions under higher-fidelity conditions followed by in-situ trials across selected regional centers.

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Prior investigations of vibrotactile displays suggest they have promise for use in the healthcare domain. This exploratory study forms part of a series exploring the use of an upper arm, continuously informing, vibrotactile display of pulse oximetry for clinicians. The study focused on the effect of vigilance on participants' accuracy and latency for detecting and identifying changes in vital sign levels. Twenty-one participants were tested in a within-subjects design in four blocks of approximately 18 minutes duration each. Two blocks were a low workload condition and the other two blocks a high workload condition. Data were analysed against thresholds of 90% for accuracy and 10 seconds for response latency and workload conditions were also compared for accuracy and latency. Participants' accuracy was not better than 90% and response latency was not shorter than 10 seconds, even in the low workload conditions. Participants were slower to detect changes in the high workload condition, and detection time worsened as the experiment progressed. Taken together, the results suggest that detecting rare events places a high strain on cognition and negatively affects performance. These findings have implications for the use of vibrotactile displays and will guide further investigations into the use of vibrotactile technology in healthcare.

Moulage is used to create mock wounds and injuries for clinical education and training. We developed a moulage technique to simulate a facial gunshot wound for use in simulation-based training. We removed sections of a manikin’s face and used moulage materials to mock various aspects of the wound. The manikin was used in a simulated scenario that teaches clinicians how to manage a complicated airway. The moulage was evaluated with a self-report questionnaire that assessed participants’ perceptions of the realism of the wound, the degree to which the wound contributed to their scenario immersion, and the degree to which the wound enhanced their learning experience on a 5-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. Participants’ average response to each item was significantly higher than the neutral midpoint, and the median response was ‘strongly agree’. Our work suggests that the simulated facial gunshot wound contributed to perceived scenario immersion and enhancement of the learning experience, supporting existing literature that suggests moulage is a valuable tool in healthcare simulation. Future work could investigate the effect of moulage using objective measures and explore the potential to use extended reality technology in conjunction with moulage to improve immersion even further.