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

Abigail R Wooldridge; Pascale Carayon; Peter Hoonakker; Bat-Zion Hose; Benjamin Eithun; Thomas Brazelton 3rd; Joshua Ross; Jonathan E Kohler; Michelle M Kelly; Shannon M Dean; Deborah Rusy; Ayse P Gurses

doi:10.1016/j.apergo.2020.103059

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

Appl Ergon. 2020 May:85:103059. doi: 10.1016/j.apergo.2020.103059. Epub 2020 Feb 12.

Authors

Affiliations

¹ Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA. Electronic address: arwool@illinois.edu.
² Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
³ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
⁴ American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA.
⁵ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁶ Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁷ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁸ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁹ Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁰ Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA; Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU. We applied the Systems Engineering Initiative for Patient Safety (SEIPS) process modeling method and identified nine dimensions of barriers and facilitators - anticipation, ED decision making, interacting with family, physical environment, role ambiguity, staffing/resources, team cognition, technology and characteristic of trauma care. For example, handoffs involving all healthcare professionals in the OR to PICU transition created a shared understanding of the patient, but sometimes included distractions. Understanding barriers and facilitators can guide future improvements, e.g., designing a team display to support team cognition of healthcare professionals in the care transitions.

Keywords: Macroergonomics; Pediatric trauma care transitions; SEIPS.

MeSH terms

Child
Emergency Service, Hospital
Ergonomics*
Female
Health Personnel / organization & administration*
Humans
Intensive Care Units, Pediatric
Male
Operating Rooms
Patient Care Team / organization & administration*
Patient Transfer / organization & administration*
Systems Analysis*
Workflow

Abstract

MeSH terms

Grants and funding