Purpose
To demonstrate the use and value of the Human Factors/Ergonomics-based Systems Engineering Initiative for Patient Safety (SEIPS) family of work system models for studying and improving patient work.
Data Sources
: We conducted a review of the published empirical literature applying the SEIPS family of work system models for patient work.
Study Selection
Included studies had to: apply one of the SEIPS family of work system models to study patient work; be published in a peer-reviewed journal in English; and include analysis of data. We identified 16 articles that met our inclusion criteria.
Data Extraction
For each study we extracted: settings and situations in which models were applied; research design; study methods; model(s) used; type and number of study participants; study objective(s); whether the study included an intervention; specific aspects of the model used; knowledge generated about patient work; and benefits of using the models.
Results of data synthesis
Our analysis revealed that a majority of studies were conducted in the United States, used qualitative or mixed methods, and employed a variety of data collection techniques to study adult patient populations with chronic illness and their informal caregivers and healthcare providers performing patient work in the home and clinical setting. The studies resulted in a variety of useful products, demonstrating several benefits of using the models.
Conclusion
Our review has demonstrated the value of using the SEIPS family of work systems models to study and improve patient and family contributions to health-related work.
BACKGROUND AND OBJECTIVES: Physiologic monitor alarms occur at high rates in children's hospitals; #1% are actionable. The burden of alarms has implications for patient safety and is challenging to measure directly. Nurse workload, measured by using a version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) validated among nurses, is a useful indicator of work burden that has been associated with patient outcomes. A recent study revealed that 5-point increases in the NASA-TLX score were associated with a 22% increased risk in missed nursing care. Our objective was to measure the relationship between alarm count and nurse workload by using the NASA-TLX.
METHODS:We conducted a repeated cross-sectional study of pediatric nurses in a tertiary care children's hospital to measure the association between NASA-TLX workload evaluations (using the nurse-validated scale) and alarm count in the 2 hours preceding NASA-TLX administration. Using a multivariable mixed-effects regression accounting for nurse-level clustering, we modeled the adjusted association of alarm count with workload.
RESULTS:The NASA-TLX score was assessed in 26 nurses during 394 nursing shifts over a 2month period. In adjusted regression models, experiencing >40 alarms in the preceding 2 hours was associated with a 5.5 point increase (95% confidence interval 5.2 to 5.7; P < .001) in subjective workload.CONCLUSION: Alarm count in the preceding 2 hours is associated with a significant increase in subjective nurse workload that exceeds the threshold associated with increased risk of missed nursing care and potential patient harm.
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