Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients

Wooldridge, Abigail R.; Carayon, Pascale; Hoonakker, Peter; Hose, Bat‐Zion; Eithun, Benjamin; Brazelton, T. Berry; Ross, Joshua; Kohler, Jonathan E.; Kelly, Michelle M.; Dean, Shannon M.; Rusy, Deborah A.; Gürses, Ayşe P.

doi:10.1016/j.apergo.2020.103059

Cited by 32 publications

(20 citation statements)

References 55 publications

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“…However, physicians emphasized the impact of the individuals participating in the handoff on its efficiency (i.e., relationship between person and organization). Nonetheless, the triad of person, organization and task were the most emphasized and related work system elements described; tools and technology were not frequently mentioned, as the care transition process is not technology centric (Wooldridge et al, 2020). Negative opinions about team handoffs from physicians emphasized the triad of organization, task and physical environment, rather than the person element.…”

Section: Discussionmentioning

confidence: 99%

Comparing Physician and Nurse Opinions of Team and Individual Handoffs: Does Role Influence Preference?

Heuck

Wooldridge

2020

Proceedings of the Human Factors and Ergonomics Society Annual

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Care transitions are key to patient safety and remain a safety issue despite previous research. This study examines how the design of care transitions impacts different health care professions. Twenty-nine physicians and nurses were interviewed about operating room to intensive care unit care transitions. We compared relationships between work system elements in positive and negative opinions about two sociotechnical system designs: including team or individual handoffs. Nurses did not express positive opinions of individual handoffs or negative opinions of team handoffs, while physicians expressed positive and negative opinions of both. Relationships between work system elements varied by profession in the positive opinions about team handoffs and negative opinions about individual handoffs. Professional needs and culture may be related to the different perceptions of each handoff. Future work should continue to examine professional differences when developing a flexibly standardized process to ensure all users are considered.

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Section: Discussionmentioning

confidence: 99%

Comparing Physician and Nurse Opinions of Team and Individual Handoffs: Does Role Influence Preference?

Heuck

Wooldridge

2020

Proceedings of the Human Factors and Ergonomics Society Annual

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“…Large multidisciplinary clinical teams, such as pediatric trauma teams that include ED, operating room (OR), and ICU subteams, may particularly benefit from health IT to support team cognition, shared mental models, and situational awareness regarding a patient's past, current, and future status. 13 14 15 Using a collaborative design approach, a process that brings together team members with different ideas, roles, and backgrounds, we created health IT tool mockup aimed at supporting team cognition for the many clinicians involved in pediatric trauma care across units called the Teamwork Transition Technology or T 3 . 16 In an ideal situation, T 3 is an integrated display projected on a very large screen, near the bed of the patient in the trauma bay, or in another central location, so that all trauma team members can see a summary of the information about the patient's status and next care transitions.…”

Section: Background and Significancementioning

confidence: 99%

Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions

et al. 2022

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Background Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of children's death. Trauma care by its very nature is team based but due to the emergent nature of trauma, critical clinical information is often missed in the transition of these patients from one service or unit to another. Teamwork transition technology can help support these transitions and minimize information loss while enhancing information gathering and storage. In this study, we created a large screen technology to support shared situational awareness across multiple clinical roles and departments. Objectives This study aimed to examine if the Teamwork Transition Technology (T3) supports teams and team cognition. Methods We used a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T3. Results Results of the evaluation show that most participants agreed that the technology helps achieve the goals set out in the design phase. Respondents thought that T3 organizes and presents information in a different way that was helpful to them. Conclusion In this study, we examined a health IT (T3) that was designed to support teams and team cognition. The results of our evaluation show that participants agreed that T3 does support them in their work and increases their situation awareness.

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“…Contextual inquiry will start with the development of individual process maps for the 12 ICUs using knowledge elicitation through virtual subject matter expert interviews according to the method described by Wooldridge et al [ 42 ]. Process mapping uses human factors engineering approaches, e.g., semi-structured elicitation interviews with subject matter experts, to systematically evaluate elements of a complex sociotechnical work system in which a care process is embedded.…”

Section: Study Aims and Approachmentioning

confidence: 99%

Handoffs and transitions in critical care—understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial

et al. 2021

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Background The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings. Methods The Handoffs and Transitions in Critical Care—Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU). Discussion The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings. Trial registration ClinicalTrials.gov identifier: NCT04571749. Date of registration: October 1, 2020.

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Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients

Cited by 32 publications

References 55 publications

Comparing Physician and Nurse Opinions of Team and Individual Handoffs: Does Role Influence Preference?

Comparing Physician and Nurse Opinions of Team and Individual Handoffs: Does Role Influence Preference?

Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions

Handoffs and transitions in critical care—understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial

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