Background and objectives Medical simulation and human factors engineering (HFE) may help investigate and improve clinical telemetry systems. Investigators sought to (1) determine the baseline performance characteristics of an Emergency Department (ED) telemetry system implementation at detecting simulated arrhythmias and (2) improve system performance through HFE-based intervention. Methods The prospective study was conducted in a regional referral ED over three 2-week periods from 2010 to 2012. Subjects were clinical providers working at the time of unannounced simulation sessions. Three-minute episodes of sinus bradycardia (SB) and of ventricular tachycardia (VT) were simulated. An experimental HFE-based multi-element intervention was developed to (1) improve system accessibility, (2) increase system relevance and utility for ED clinical practice and (3) establish organisational processes for system maintenance and user base cultivation. The primary outcome variable was overall simulated arrhythmia detection. Pre-intervention system characterisation, post-intervention end-user feedback and real-world correlates of system performance were secondary outcome measures. Results Baseline HFE assessment revealed limited accessibility, suboptimal usability, poor utility and general neglect of the telemetry system; one simulated VT episode (5%) was detected during 20 pre-intervention sessions.
Study simulations delineated EDPS and assessed safety behaviors in senior emergency medicine residents, who exhibited the requisite medical knowledge base and procedural skill set but lacked some nontechnical skills that pertain to emergency department microsystem functions and patient safety. The experimental system exhibited limited impact only on in-simulation time-out compliance.
The goal of the development phase of the CPR Instructor Real-time Review through Use of Simulation (CIRRUS) research program was to create a video library portraying a spectrum of objectively verified simulation chest compression performances. Investigators scripted and recorded 12 two-person cardiopulmonary resuscitation (CPR) videos with specific chest compression parameters encompassing a range of hand positions, rates, depths, and chest releases in combinations that proportionately reflected typical learner cohort performances. Six videos were designated to portray adequate chest compressions, whereas the other six videos were to feature inadequate compressions. All 12 final 2-minute videos showed chest compression parameters as originally specified within tolerances to comply with American Heart Association recommendations. Deviations from specification were 1 to 10 cpm (mode = 4 cpm) for compression rate and -1.4 to 1.3 cm (mode = 0.9 cm) for depth. The program's collection of simulated CPR videos with objectively verified chest compression performances may help researchers and educators study and improve CPR instruction and provider preparation for the effective delivery of optimal patient care.
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