Human Factors in Healthcare Blog

A few weeks ago I was teaching about human factors engineering to a group of hospitalists at the Society for Hospital Medicine meeting.  Many of the hospitalists (physicians focused on delivering care mostly in hospitals) in the audience had a minor or major role in making things safer in thier organization.  Some had no idea about human factors engineering, or had heard it described as the study of factors that make us flawed humans. 

Personally, I like my former co-worker’s definition that focuses on ergonomics.  Since his early days at NASA was around engineers building new crew capsules, he defined human factors engineers as ”the group of people who measure people’s butt cheeks to design the seat so it fits!”

I have tried many methods to introduce HFE to novices, but the two main methods are interactive exercises and demonstrations that put people in position of seeing things that were previously underappreciated.  An exercise I tried for the first time at the SHM meeting was to have two groups of 2 people try to find the location of an AED.  The scenario was that I suffered a heart attack and they had called 911 and were pursuing an AED that they believed was mounted on the wall somewhere in the hotel conference center. [previously, I have written about signage for AEDs].

On each team, one person was assigned to find the AED and think aloud about their plan and other thoughts.  The other person was to record those words and actions – especially where the searcher was looking and resources they sought to find the AED.  The room had exits to different hallways for each team to began searching. 

In short, one person immediately asked hotel personnel, who did not know.  Then they asked conference information desk, who pointed across the middle, large hallway to the easily visible AED sign and wall storage unit.  The other person just had instincts to look centrally in the 400 foot main hallway, and was correct.  Neither used their smart phone, their map included in the conference agenda book, or other tools you might consider if not in a hurry – or, where they in a conference room answering questions in a laid back inteview.  There are a few studies on so-called wayfinding for designing hallway signs, but I have not seen any for searching and finding AEDs?  Do any of you know of some?

Interestingly, when someone did look at the hotel map, it provided locations of three things (besides room numbers-names):

1. Bathrooms
2. ATMs
3. Where you were allowed to smoke

In debriefing the two physicians who were frantically looking for the AED, they did provide one CAUTION to me about doing this exercise again:  make sure the people looking for the AED tell the information desk or other personnel that it is an EXERCISE, and no need to call 911!

My son decided to stress test his parents with 60% body rash last Saturday.  We keep a pretty “clean” and food consistent house due to our daughters allergies to 9 food ingredients (from peanuts to poppy seeds!).  So, we could not figure out the rash and were worried it could “spread” to his respiratory system (this has happened with our daughter).  On Sunday, 5AM, his rash worsened and moved into his eyelid area and mouth.

Every time I visit the emergency room with a family member, I cannot dismiss the fact I know that colleagues of mine study the relative design chaos that “lives here”.  Plus, sifting out the bad illnesses from horrible illnesses from run-of-the-mill illnesses is not that easy.  Missing diagnosis is a common reliability issue with super experts, much less someone half asleep and over-worked.

In short, after six physicians in three settings across 2 days saw my son with 40-60% body and facial rash, we took prednisilone and Benadryl until he was bouncing off the walls!  Even though the medications did not seem to work at first, in a few days he was back to his normal bouncing-off-the-walls self, with no rash.

The hardest thing for my wife and I was keeping track of the medication and dosing.  6.25 ml of Prednisilone…really?   10 mL Benadryl as every 6 hours, 5mL Ranitidine as every 8 hours, and 6.25 (then 5mL) Prednisilone as every 12 hours (or twice a day).  Oh, and sometimes we forgot one and then gave it, but 2 hours off cycle.  Needless to say, we used paper medication records to keep track and still messed up (double doses and missed doses).  Anyone who can figure out how to design a way out of this design mess, in a robust, usable, and well-accepted by physicians, will be a billionaire!

Oh, yeah, the markings on the picture of that medication measuring cup are kind of hard to see.  REALLY exciting at 2AM!

It happened 5 years ago, but I am always reminded of it when I board a plane.  The PA announcement on my return flight from a conference in Las Vegas was something like this: “there is a medical emergency.  Is there any medical people to help us in the back of the plane?”  I was towards the front of the plane and looked back to see no one standing up.  I reluctantly went to the back to find a semi-conscious middle-aged man and two flight attendants who looked worried.  I had not practiced medicine in 15 years, but had some recurring training and exposure to emergency care.  When we removed the in-flight med kit, we found bandages, aspirin, a small EKG machine, and little else.  I wanted an AED (automated external defibrillator), but none was aboard.  Long story short, I assessed him, spoke by teletype to medical consultants at Mayo Clinic, the plane kept flying, and he eventually did okay and left the plane under his own power.

Because of this encounter, and HFE work I have done with AEDs and defibrillators,  it always catches my eye when I see an AED.  Just last week I took pictures of an AED and surrounding signage in the Atlanta airport.

As I did, you might notice a few design-related things:

1. The AED Sign is one of the largest ones I have seen.  If you think of running around a busy and visually cluttered terminal, there is no way this sign can be too big
2. The AED is below the sign, but having other items so close might warrant a second sign; plus the added bonus that your vision might be blocked from one or the other sign by people.
3. The directions on the AED cabinet are not really clear.  Do you yank it open?  Break the glass?  If the alarm sounds when you open it, why not have “it” call 911?
4. Perhaps it would be ominous, but having a poster on CPR and the main steps for using an AED (like you see in restaurants showing the Heimlich Maneuver steps for choking)

What are your thoughts?