We introduce the concept of machine fitness assessment, which is the process of correctly determining the degree of fit between a machine’s inferences on a specific world and the world itself. We describe its importance in complex, high-stakes worlds, including healthcare, and how it will be critically important to realize the potential of consumer health technologies that promise institutional-quality health diagnosis and planning in decidedly non-institutional settings (e.g., our homes, offices, or anywhere else).
Background
Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events.
Methods
The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework.
Results
A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans.
Conclusions
The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.
Despite noticeable efforts over the last 30 years to try and resolve the clinical alarm problem, the utilization of opinion-based and nonscientific alarm interventions has resulted in ineffective solutions. The field of human factors offers many insights to permanently solving the burdens of this problem, however often times the field’s direct applications are not salient or tangible enough to organizational stakeholders. This has resulted in a utilization deficit of human factors principles in practice today. In order to progress the level of impact human factors has on the clinical alarm problem for the future, this paper discusses how a human factors team tested science-based clinical alarm solutions within a multidisciplinary medical center, and then navigated tradeoffs in order to implement these solutions into practice.
After use, surgical instruments are sent to a Sterile Processing Department (SPD) or facility to be cleaned, reorganized, maintained, sterilized and stored for eventual re-use. Though essential for safe, efficient and cost-effective surgical delivery, the functions, trade-offs and outcomes within SPDs have rarely been studied. Patient safety incident (PSI) reports are the most ubiquitous form of safety data collected within acute care environments and are often used to report issues in the SPD. Using the work systems analysis perspective we developed in previous work, we created a framework for areas where system failures might occur and manually evaluated PSI reports to investigate a period of possible system strain. We identify the assembly stage as a potentially significant contributor to system strain in the SPD and suggest that several issues related to sterile processing may be interconnected with an aim to assist decisionmakers and healthcare team members in SPD system management.
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