Human factors/ergonomics professionals are improving health care

The latest issue of Human Factors: The Journal of the Human Factors and Ergonomics Society contains a special section describing ways in which human factors/ergonomics professionals are improving health care.

Guest editor Eduardo Salas notes in his preface, "we hope that this special section encourages research, debate, new ideas, better theories, practical interventions, and useful findings to ameliorate errors in health care....The most significant factor in making the nation's health care system safer is the human element. And that is our business."

Nine articles cover a wide range of devices, systems, and processes. Several of the articles cover findings and recommendations for improved medical displays:

• Minimally invasive surgery (MIS) relies heavily on imaging devices that display the inside of the body. Despite its benefits to patients, MIS presents challenges to surgeons because of reduced field of view and degraded depth perception. The results of DeLucia and colleagues suggest ways that surgeons can navigate better during MIS.
• Something as simple as using capital ("tall man") letters to highlight sections of drug names on labels may lead to fewer errors in dispensing drugs that have similar-looking names. Filik et al. found that using tall man letters to emphasize differences in similar names resulted in increased attention to high-risk drug names.
• When sudden changes occur in patients under anesthesia, anesthesiologists rely on displays to help them identify the problem and remedy it. This literature review by Drews and Westenskow shows that graphical displays can improve patient safety, though few are in use today. They suggest ways to improve such displays.
• Providing feedback to the user is critical in ensuring that a procedure is being performed accurately. Drews and colleagues found that when anesthesiologists were able to view a display that visualized drug concentrations in a simulated patient, they could more precisely and safely monitor anesthesia.

Other articles focus on changes in behavior or the environment that could result in increased patient safety:

• The work environment can affect nurses' ability to maintain priorities and stay organized. Wolf et al. used task and link analysis to demonstrate that on average, the group of nurses studied "had 10 or more activities waiting to be performed and experienced 3.4 interruptions per hour." These findings may lead to methods and techniques to reduce stress among nurses.
• Bar Code Medication Administration (BMCA) systems are intended to prevent giving the wrong medication to hospital patients - if used correctly. While observing nurses in Veterans Health Administration sites, Patterson and colleagues discovered that they adopt a variety of workaround strategies that could result in errors and risk to patients. The researchers suggest ways to minimize workarounds.
• It can be difficult to diagnose the severity of the condition of a person exhibiting signs of acute cardiac ischemia, even for seasoned physicians. Computer-based decision support tools that help doctors predict serious events are not widely used for reasons that are not well understood. Lai et al. developed a Web-based tutorial that physicians said increased their level of understanding of one such tool.

The special section also includes these important studies:

• Using a qualitative user-center design approach, Escoto et al. found that physicians and clinical assistants differ on some of the issues that medical error reporting systems might capture. Implementing such reporting systems might lead to better patient care if these systems are designed with the users' professional cultures and other factors in mind.
• Training health care workers to draw blood for testing has traditionally been done on a low-tech, simulated arm, which performed better in a comparison by Scerbo and colleagues versus performance using a high-tech virtual reality simulator. Analysis suggests that the design of new medical VR technologies must adhere to human factors principles if they are to facilitate training and improve patient safety.