The audibility and the identification of 23 auditory alarms in the intensive care unit (ICU) and 26 auditory alarms in the operating rooms (ORs) of a 214-bed Canadian teaching hospital were investigated. Digital tape recordings of the alarms were made and analysed using masked-threshold software developed at the Université de Montréal. The digital recordings were also presented to the hospital personnel responsible for monitoring these alarms on an individual basis in order to determine how many of the alarms they would be able to identify when they heard them. Several of the alarms in both areas of the hospital could mask other alarms in the same area, and many of the alarms in the operating rooms could be masked by the sound of a surgical saw or a surgical drill. The staff in the OR (anaesthetists, anaesthesia residents, and OR technologists) were able to identify a mean of between 10 and 15 of the 26 alarms found in their operating theatres. The ICU nurses were able to identify a mean of between 9 and 14 of the 23 alarms found in their ICU. Alarm importance was positively correlated with the frequency of alarm identification in the case of the OR, rho = 0.411, but was not significantly correlated in the case of the ICU, rho = 0.155. This study demonstrates the poor design of auditory warning signals in hospitals and the need for standardization of alarms on medical equipment.

Team Situation Awareness (TSA) is one of the critical factors in effective Operating Room (OR) teamwork and can impact patient safety and quality of care. While previous research showed a relationship between situation awareness, as measured by communication events, and team performance, the implications for developing technology to augment and facilitate TSA were not examined. This research aims to further study situation-related communications in the cardiac OR in order to uncover potential degradation in TSA which may lead to adverse events. The communication loop construct-the full cycle of information flow between the participants in the sequence-was used to assess susceptibility to breakdown. Previous research and the findings here suggest that communication loops that are open, non-directed, or with delayed closure, can be susceptible to information loss. These were quantitatively related to communication indicators of TSA such as questions, replies, and announcements. Taken together, both qualitative and quantitative analyses suggest that a high proportion of TSA-related communication (63%) can be characterized as susceptible to information loss. The findings were then used to derive requirements and design a TSA augmentative display. The design principles and potential benefits of such a display are outlined and discussed.

Overall, this pilot study implies that a situation display could facilitate better teamwork and team communication in the resuscitation event.

Emergency resuscitation team participants felt the Situational Awareness Display has potential to improve provider performance, team communication and situational awareness, ultimately enhancing quality of care.

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A 1-day point-prevalence study was conducted in our 141-bed tertiary cardiac care hospital in order to determine our patients' and their significant others' level of understanding of cardiac risk factors in general and of the patients' personal cardiac risk factors. There were 3 parts to the study: patient interviews, significant other (SO) interviews, and an audit of the participating patients' charts. Of the 87 patients who were able to participate, 71 completed the interviews as did 53 significant others. From recall, only 14 patients and 11 significant others were able to define what a cardiac risk factor was ("Habits or factors that contribute to heart disease") and they were unable to identify many general risk factors. However, when given a recognition task where cardiac risk factors were interspersed with sham factors, the overall mean general knowledge score was 13.6 for patients and 13.9 for significant others out of 16. The correlation between the patients' understanding of their cardiac risk factors and the significant others' understanding of them was reasonably good (r = 0.58, P < .0001), as was the correlation between the SOs' understanding and the charts (r = 0.58, P < .0001). There was less agreement between the patients' understanding and the chart documentation of cardiac risk factors (r = 0.36, P < .01). The findings of this study have implications for patient teaching as well as for documentation of cardiac risk factors.

Cognitive work analysis (CWA) as an analytical approach for examining complex sociotechnical systems has shown success in modelling the work of single operators. The CWA approach incorporates social and team interactions, but a more explicit analysis of team aspects can reveal more information for systems design. In this paper, Team CWA is explored to understand teamwork within a birthing unit at a hospital. Team CWA models are derived from theories and models of teamworkand leverage the existing CWA approaches to analyse team interactions. Team CWA is explained and contrasted with prior approaches to CWA. Team CWA does not replace CWA, but supplements traditional CWA to more easily reveal team information. As a result, Team CWA may be a useful approach to enhance CWA in complex environments where effective teamwork is required.Practitioner Summary: This paper looks at ways of analysing cognitive work in healthcare teams. Team Cognitive Work Analysis, when used to supplement traditional Cognitive Work Analysis, revealed more team information than traditional Cognitive Work Analysis. Team Cognitive Work Analysis should be considered when studying teams

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