Papers by Patricia Trbovich
CMAJ Open, 2020
D rug losses and thefts cost health care facilities in investigations, care for patients with ina... more D rug losses and thefts cost health care facilities in investigations, care for patients with inadequately treated pain or harmed by drug substitution or tampering, and reputation-related damages. 1-9 Furthermore, losses from health care facilities have the potential to increase illegal supply of opioids via trafficking. In the United States, the Drug Enforcement Agency reports annually on opioid losses from health care institutions (e.g., community pharmacies, hospitals). 10,11 The Canadian authority that captures data on opioid losses from health care facilities, Health Canada, does not publish an equivalent report. Since 2006, 12 any individuals or organizations in Canada licensed to produce, package, assemble, sell or transport opioids are mandated to report losses to Health Canada by fax or email within 10 days 13 (see reporting form in Appendix 1, section 9, available at www.cmajopen. ca/content/8/1/E113/suppl/DC1). This group includes, but is not limited to, a wide variety of facilities such as hospitals, community pharmacies, all companies (e.g., drug manufacturers), long-term care homes and veterinary hospitals. Health Canada conducts random, targeted inspections of community pharmacies to assess compliance with the mandate, 14 but data on hospital inspections are scarce. Local regulatory
Usability tasks tested with pass rates as percentage and fraction of total users. (DOCX 42 kb)
Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care
Background and aims: Children with congenital heart disease (CHD) are at risk of deterioration in... more Background and aims: Children with congenital heart disease (CHD) are at risk of deterioration in the face of common childhood illnesses, and their resuscitation and acute management is often best achieved with the guidance of CHD experts. Access to such expertise may be limited outside specialty heart centers and the fragility of these patients is cause for discomfort among many emergency medicine physicians. An understanding of the differences in macrocognition of these clinicians could shed light on some of the causes of discomfort and facilitate the development of a sociotechnological solution to this problem. Methods: Cardiac intensivists (CHD experts) and pediatric emergency medicine physicians (non-CHD experts) in a major academic cardiac center were interviewed using the critical decision method. Interview transcripts were coded deductively based on Klein’s macrocognitive framework and inductively to allow for new or modified characterization of dimensions. Results: While bo...
Every year, tens of thousands of patients in North America die from preventable errors. Incident ... more Every year, tens of thousands of patients in North America die from preventable errors. Incident reporting and learning provide a means of decreasing this number, but due to several barriers, these systems are not currently reaching their full potential in health care. The goal of this study is to improve patient safety by designing strategies to advance incident learning in health care. A literature review was conducted to gather details about health care, aviation, and nuclear power incident learning systems. This information was used to identify areas for improvement in health care’s incident learning processes and extract potential strategies for improvement. The suggested strategies to be developed in this research could be followed by administrators who are making crucial decisions pertaining to the incident learning process. This should help create more effective systems, and in turn, improve patient safety.
HumanEra was commissioned to write this book by the International Federation for Medical and Biol... more HumanEra was commissioned to write this book by the International Federation for Medical and Biological Engineering’s (IFMBE) Clinical Engineering Division (CED) to support biomedical technology professionals in using human factors methods to improve the safety of health technology within a range of organizations. For the purposes of this book, a biomedical technology professional refers to any person, regardless of their title (e.g., clinical engineer, biomedical engineer, biomedical equipment technician, medical technology manager, materials manager, health technology manager, administrator, clinician), responsible for managing technology in a healthcare setting. While they are not explicitly referenced throughout the book, the intent is to support patient safety leaders of all roles and titles in their efforts to improve health technology safety, as well as students learning to master human factors methods for applications in healthcare. Show full item record
BMC Health Services Research
Background Patient safety is a worldwide problem, and the patient contribution to mitigate the ri... more Background Patient safety is a worldwide problem, and the patient contribution to mitigate the risk of patient harm is now recognized as a cornerstone to its solution. In order to understand the nature of integrating patients into patient safety and healthcare organizations and to monitor their integration, a Canadian survey tool has been co-constructed by patients, researchers and the Canadian Patient Safety Institute (CPSI). This questionnaire has been adapted from the French version of the patient engagement (PE) in patient safety (PS) questionnaire created for the province of Quebec, Canada. Methodology The pan-Canadian PE in PS survey tool was developed in a five-step process: (1) a literature review and revision of the initial tool developed in the province of Quebec; (2) translation of the French questionnaire into an English version tool; (3) creation of a Canadian expert advisory group; (4) adaptation of the English version tool based on feedback from the expert advisory gr...
Journal of Patient Safety
OBJECTIVES Inpatient hospital pharmacies have a central role in managing controlled substances (C... more OBJECTIVES Inpatient hospital pharmacies have a central role in managing controlled substances (CS) throughout the hospital medication use process (MUP). Our objectives were to identify vulnerabilities for diversion in the MUPs of 2 inpatient pharmacies, explore differences between the sites, and characterize the types of vulnerabilities identified. METHODS We conducted clinical observations in 2 pharmacies to map their MUPs and performed a healthcare failure mode and effect analysis to proactively identify (1) the critical failure modes (CFMs) that make them vulnerable to diversion and (2) the controls that prevent, mitigate, or enhance the detectability of CFMs. RESULTS We conducted 99 hours of observations between May-June and September-October 2018. We observed 36 pharmacy technicians, 4 pharmacists, and 1 clerk as they conducted tasks involving 4 processes common to both sites: procuring CS, receiving CS deliveries to the pharmacy, unit-dose packaging CS oral solids, and distributing CS to hospital units. The tasks and subtasks we mapped in the process flow diagrams led to the identification of 220 failure modes. Of these, 34 were deemed CFMs and were categorized as related to handling CS, data entry, or verification tasks. Three of the CFMs were unique to one site, given that the other site had a control for the CFM. CONCLUSIONS Multiple vulnerabilities for diversion exist in inpatient pharmacy processes. Our results provide some much needed detail about how specific vulnerabilities in MUP tasks and subtasks lead to an increased risk of diversion.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting
Communication errors are the leading root cause of preventable adverse events in hospitals. Patie... more Communication errors are the leading root cause of preventable adverse events in hospitals. Patient care rounds provide the most important opportunity for interprofessional communication; however, rounds involve many interprofessional team members, and it can be challenging to achieve optimal communication and team functioning. While rounding best practices have been identified, implementations of best practices have produced mixed results, and little emphasis has been placed on explicitly aligning interventions to user needs. The goal of this study was to elucidate health care providers’ (HCPs) rounding needs and to align intervention design to those needs to improve interprofessional communication within a paediatric critical care unit (CCU). Interview and survey data were collected to identify needs and a participatory design approach was taken to transform needs into intervention(s). The main needs identified led to specific changes included in the intervention design such as ch...
BMJ Quality & Safety
IntroductionTrauma resuscitation is a complex and time-sensitive endeavour with significant risk ... more IntroductionTrauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical situations that may manifest LSTs. Using ISS coupled with a human factors-based video review and modified framework analysis, we sought to identify and quantify LSTs within trauma resuscitation scenarios.MethodsAt a level 1 trauma centre, we video recorded 12 monthly unannounced ISS to prospectively identify trauma-related LSTs. The on-call multidisciplinary trauma team participated in the study. Using a modified framework analysis, human factors experts transcribed and coded the videos. We identified LST events, categorised them into themes and subthemes and used a hazard matrix to prioritise subthemes requiring intervention.ResultsWe identified 843 LST events during 12...
Q 200 1, Paticia Tbvich uiaitbns and Acquisitions et Bi iogmphic SeMces senrices bibliographiques... more Q 200 1, Paticia Tbvich uiaitbns and Acquisitions et Bi iogmphic SeMces senrices bibliographiques ibl The author has graated a nonexclusive iicence allowiug the National L iof Cana& to repmduce, loan, distri'bute or sel copies ofthis thesis m mimform, papa or electronic formats. The author retains ownership of the copyright in this thesis. Neither the thesis nor substantial extracts fiom it may be prnired or othedse reproduced without the author's permissian. L'auteur a accordé une licence non exclusive permettant & la Bibliothéque nationale du Canada de reproâuire, prêter, distribuer ou vendre des copies de cette thèse sous la fame de microfiche/fih, de reproduction sur papier ou sur format électronique. L'auteur amsme la propndté du droit d'auteur qui protège cette thèse. Ni la thèse ni des extraits substantiels de celle-ci ne doivent être imprimes ou autrement reproduits sans son autorisatim. 7 Thanks to JO-Anne LeFevre, for not only being an amazing supervisor but a great h n d. Thank you fbr going way beyond the cal1 of duty, to help me meet my objective. I hope to r e m the favour. You have taught me so much. By sharing in your excellence, 1 am inspireci to reach my own. Thank you Chris Iierdman. Tbanks to you, 1 had a story wonh telling. Thanks Mom, your unconditional support has ban the source of my strength. 1 am especially grateful for ail the cups of coffee you kept bringing to my desk. Thanks Dad, 1 don't know where i'd be without you, but I'd hate to go there and fhd out. Thanks Kim and Damy, without your suppoit and encouragement I wodd have gone mad long aga. Thank you Me! for your suppofi and help, you gave so selflessly. And last but not least, thank you Brenda fOr al1 your help. The sheer joy of working with you has ben wonderful.
This dissertation reports on a thesis that examined the extent to which manipulations of secondar... more This dissertation reports on a thesis that examined the extent to which manipulations of secondary task perceptual and processing demands have an impact on performance of a simulated driving task. The driving simulation feature a Lane Change Test (LCT) and the adults (n = 112) in the study performed the lane change test alone and also concurrently with secondary tasks. These secondary tasks required phonological, visual, or spatial processing. Results showed that participants' lane change performance was significantly worse when secondary tasks were perceived visually than when perceived auditorily. This was true regardless of whether the prompts the drivers received were given visually (i.e., visual road signs on the simulator) or auditorily (i.e., auditory commands). The author also considered lane change performance measures broken down into three components: lane change initiation, lane maneuver quality, and lane position maintenance. The author concludes that performance of secondary tasks can interfere with driving performance and provide much needed detail about how specific perceptual and processing resources are involved in the performance of secondary tasks and driving.
Canadian Journal of Nursing Research
Purpose To qualitatively contrast emergency department triage workflow using a paper-based triage... more Purpose To qualitatively contrast emergency department triage workflow using a paper-based triage system and an electronic decision-support tool (electronic Canadian Triage and Acuity Scale (eCTAS)). Methods Triage nurses from a single institution were invited to perform triage assessments of mock patients using a paper-based triage system and eCTAS. These assessments were completed using simulation scenarios, some of which involved facilitators probing triage nurses’ thoughts on the design of the eCTAS system. Participants were asked to “think aloud,” describing their thought patterns as they completed the triage process. Similar patient scenarios with the same Canadian Emergency Department Information System (CEDIS) presenting complaint and triage score were used for comparison between paper-based triage and electronic decision-support tool (eCTAS) conditions. Results Eight participants completed at least two simulation scenarios for each condition and at least one usability scena...
BMJ Open
IntroductionAn increasing number of opioids and other controlled substances are being stolen from... more IntroductionAn increasing number of opioids and other controlled substances are being stolen from healthcare facilities, diverting medications from their intended medical use to be used or sold illicitly. Many incidents of medication loss from Canadian hospitals are reported as unexplained losses. Together, this suggests not only that vulnerabilities for diversion exist within current medication-use processes (MUPs), but that hospitals lack robust mechanisms to accurately track and account for discrepancies and loss in inventory. There is a paucity of primary research investigating vulnerabilities in the security and accounting of medications across hospital processes. The purpose of this study is to map hospital MUPs, systematically identify risks for diversion or unintentional loss and proactively assess opportunities for improvements to medication accounting and security.Methods and analysisWe will conduct human factors-informed clinical observations and a Healthcare Failure Mode...
Nursing Open
Electronic health records (EHRs) have been implemented in healthcare organizations worldwide (Sto... more Electronic health records (EHRs) have been implemented in healthcare organizations worldwide (Stone, 2014). These systems are installed so that organizations can achieve several benefits such as enhanced patient safety (Savage, Titus, Manns, & Lee, 2014), better documentation (Dowding, Turley, & Garrido, 2012) and improved quality of care (Plantier et al., 2017). However, previous research has demonstrated that simply implementing an EHR does not mean that healthcare organizations will achieve these intended benefits
Journal of Critical Care
PURPOSE Although intensive care clinicians are expected to make data-driven critical decisions us... more PURPOSE Although intensive care clinicians are expected to make data-driven critical decisions using the technologies available to them, the effect of those technologies on decision-making are not well understood. Using the macrocognitive framework, we studied critical decision-making and technology use to understand how different specialists within teams make decisions and guide the development of decision-making support technologies. MATERIALS AND METHODS The Critical Decision Method was used to understand the macrocognitive processes used during critical decision-making of twelve critical care clinicians. Deductive (based on the macrocognition framework) and inductive coding were used to analyze the macrocognitive processes, their interrelationships, and their relation to technologies. RESULTS Over 60% of critical decision-making macrocognition was devoted to Sensemaking, Anticipation, and Communication. The most technology-mediated process was Sensemaking. Of particular note, physicians and respiratory therapists extracted information for their own use, while nurses extracted information to communicate to others. Physicians switched between ten macrocognitive processes, whereas nurses and respiratory therapists switched between five processes. CONCLUSIONS This exploratory study provides much needed details about the different ways in which specialists use technologies to support decision-making tasks, particularly those involving sensemaking, which are essential to the design and development of decision-support technologies.
Proceedings of the 4th International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle
The Lane Change Test (LCT) is an easy-to-implement, low-cost methodology for the evaluation of th... more The Lane Change Test (LCT) is an easy-to-implement, low-cost methodology for the evaluation of the distraction associated with performing invehicle tasks while driving (Mattes, 2003). In the present study, the LCT was used to assess driving performance when drivers completed navigation tasks using visual-manual or speech-based interfaces. Drivers performed two types of navigation tasks at two levels of difficulty. The results provide support for the LCT as an effective measure of distraction for both types of interface. It is recommended that the LCT procedure incorporate additional measures beyond the current mean deviation measure. Two measures are suggested: Lane Change Initiation, which reflects the aspects of driving having to do with detection and response delay as a result of distraction, and a measure of task duration to account for risk exposure.
Annals of Surgery
Objective: To identify and categorize system factors in complex laparoscopic surgery that have th... more Objective: To identify and categorize system factors in complex laparoscopic surgery that have the potential to either threaten patient safety or support system resilience. Background: The operating room is a uniquely complex sociotechnical work system wherein surgical successes prevail despite pervasive safety threats. Holistically characterizing intraoperative factors that thus support system resilience in addition to those that threaten patient safety using contextual methodologies is critical for optimizing surgical safety overall. Method: In this prospective descriptive interdisciplinary study, 19 audio/video recordings of complex laparoscopic general surgical procedures were directly observed and transcribed. Using a qualitative systems-based approach, intraoperative human factors with the potential to impact patient safety, either as a safety threat or as a support for resilience, were identified. Adverse events were further assessed for shared threats and supports. Data collection was guided by the Systems Engineering Initiative for Patient Safety 2.0 work system model. Results: A total of 1083 relevant observations were made over 39.8 hours of operative time, enabling the identification of 79 distinct safety threats and 67 resilience supports within the surgical system. Safety threats associated with the physical environment, tasks, organization, and equipment were prevalent and observed in equal measure, whereas supports for resilience were predominantly attributed to clinician behaviors, including proactive team management and skills coaching. Two subclinical adverse events were identified; shared safety threats included suboptimal technology design, whereas shared resilience supports included calm clinician behavior and redundant intraoperative resourcing. Conclusions: Safety threats and resilience supports were found to be systematic in the surgical setting. Identified safety threats should be prioritized for remediation, and clinician behaviors that contribute to fostering resilience should be valued and protected.
BMJ Simulation and Technology Enhanced Learning
IntroductionClinician movement and workflow analysis provides an opportunity to identify ineffici... more IntroductionClinician movement and workflow analysis provides an opportunity to identify inefficiencies during trauma resuscitation care. Inefficient workflows may represent latent safety threats (LSTs), defined as unrecognised system-based elements that can negatively impact patients. In situ simulation (ISS) can be used to model resuscitation workflows without direct impact on patients. We report the pilot application of a novel, tracing tool to track clinician movement during high-fidelity ISS trauma sessions.MethodsTwelve unannounced ISSs were conducted. An open source, Windows-based video overlay tracing tool was developed to generate a visual representation of participant movement during ISS. This tracing tool used a manual mouse tracking algorithm to produce point-by-point location information of a selected participant in a video. The tracing tool was applied to video recordings of clinicians performing a cricothyroidotomy during ISS trauma scenarios. A comparative workflow a...
BMJ quality & safety, Jan 18, 2018
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Papers by Patricia Trbovich