153 results found
Buckle P, Micocci M, Tulloch J, et al., 2021, COVID-19 point-of-care testing in care homes: what are the lessons for policy and practice?, Age and Ageing, Vol: 50, Pages: 1442-1444, ISSN: 0002-0729
COVID-19 has devastated care homes. Point-of-care tests (POCTs), mainly using lateral flow devices (LFDs), have been deployed hurriedly without much consideration of their usability or impact on care workflow. Even after the pandemic, POCTs, particularly multiplex tests, may be an important control against spread of SARS-CoV-2 and other respiratory infections in care homes by enabling identification of cases. They should not, however, replace other infection control measures such as barrier methods and quarantine. Adherence to LFDs as implemented among care home staff is suboptimal. Other tests-such as point-of-care polymerase chain reaction and automated antigen tests-would also need to be accommodated into care home workflows to improve adherence. The up-front costs of POCTs are straightforward but additional costs, including staffing preparation and reporting processes and the impacts of false positive and negative tests on absence rates and infection days, are more complex and as yet unquantified. A detailed appraisal is needed as the future of testing in care homes is considered.
Micocci M, Borsci S, Thakerar V, et al., 2021, Attitudes towards Trusting Artificial Intelligence Insights and Factors to Prevent the Passive Adherence of GPs: A Pilot Study, JOURNAL OF CLINICAL MEDICINE, Vol: 10
Tase A, Buckle P, Ni MZ, et al., 2021, Medical device error and failure reporting: Learning from the car industry, Journal of Patient Safety and Risk Management, Vol: 26, Pages: 135-141, ISSN: 2516-0435
BackgroundImproving the design of technology relies in part, on the reporting of performance failures in existing devices. Healthcare has low levels of formal reporting of performance and failure of medical equipment. This paper examines methods of reporting in the car industry and healthcare and aims to understand differences and identify opportunities for improvement within healthcare.MethodsA literature search was carried out in Pubmed, Medline, Embase, Engineering Village, Scopus. NHS England and MHRA publications and guidelines were also reviewed. Focus was placed on the current system of reporting in both industries, known degree of patient harm, initiating factors, barriers, quality and methods of incident investigation and their validity. The findings were used to compare error reporting system in the two industries.ResultsDerivation of healthcare incident data from different sources means the full extent of patient harm is not known. For example, in 2012 there were 13,549 and 38,395 incidents reported by MHRA and NRLS (National Reporting and Learning System) respectively leading to uncertainties on the extent of the problem. The car industry emphasises the role of reporting source in ensuring data quality. Utilising some aspects of this approach might benefit healthcare reporting. These include a specific reporting system that stresses the importance of organisational learning in improving safety and recognises the limitations of root cause analysis.ConclusionsLearning from reporting systems within the car industry may help the healthcare sector improve its own reporting, aiding healthcare performance.
Micocci M, gordon A, Allen J, et al., 2021, COVID-19 testing in English care homes and implications for staff and residents, Age and Ageing, Vol: 50, Pages: 668-672, ISSN: 0002-0729
IntroductionCare home residents are at high risk of dying from COVID-19. Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs).Methods:Ten staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within, and needs arising from, current pathways.Results:Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure, and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion:Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.
Kierkegaard P, McLister A, Buckle P, 2021, Rapid point-of-care testing for COVID-19: quality of supportive information for lateral flow serology assays, BMJ Open, Vol: 11, ISSN: 2044-6055
Objective There is a lack of evidence addressing several important human factors questions pertaining to the quality of supportive information provided by commercial manufacturers that can affect the adoption and use of lateral flow serology assays in practice. We aimed to: (1) identify and assess the quality of information that commercial manufacturers provided for their point-of-care tests (POCTs) and (2) examine the implications of these findings on real-world settings.Design We used a content analysis methodology in two stages to systematically, code and analyse textual data from documents of commercial manufacturers. A deductive approach was applied using a coding guide based on the validated Point-of-Care Key Evidence Tool (POCKET) multidimensional checklist. An inductive approach was used to identify new patterns or themes generated from our textual analysis.Setting Publicly available supportive information documents by commercial manufacturers for lateral flow serology, were identified and gathered from online searches.Participants Supportive information documents retrieved from online searches over 3 months (March 2020 to June 2020).Results A total of 79 POCTs were identified that met the study inclusion criteria. Using the POCKET coding guide, we found that the quality of information varied significantly between the manufacturers and was often lacking in detail. Our inductive approach further examined these topics and found that several statements were vague and that significant variations in the level of details existed between manufacturers.Conclusions This study revealed significant concerns surrounding the supportive information reported by manufacturers for lateral flow serology assays. Information transparency was poor and human factor issues were not properly addressed to mitigate the risk of improper device use, although it should be noted that the results of our study are limited by the data that manufactures were prepared to disclose. Over
Borsci S, Buckle P, Walne S, 2020, Is the LITE version of the usability metric for user experience (UMUX-LITE) a reliable tool to support rapid assessment of new healthcare technology?, APPLIED ERGONOMICS, Vol: 84, ISSN: 0003-6870
Ni M, Borsci S, Walne S, et al., 2020, The Lean and Agile Multi-dimensional Process (LAMP) - a new framework for rapid and iterative evidence generation to support health-care technology design and development, EXPERT REVIEW OF MEDICAL DEVICES, Vol: 17, Pages: 277-288, ISSN: 1743-4440
Borsci S, Buckle P, Walne S, et al., 2019, Trust and Human Factors in the Design of Healthcare Technology, 20th Congress of the International-Ergonomics-Association (IEA), Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 218-226, ISSN: 2194-5357
Borsci S, Uchegbu I, Buckle P, et al., 2017, Designing medical technology for resilience: Integrating health economics and human factors approaches, Expert Review of Medical Devices, Vol: 15, Pages: 15-26, ISSN: 1743-4440
INTRODUCTION: The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of the existing healthcare system and a failure to recognise the need to generate resilient products. Areas covered. Recognising a cross-disciplinary need to enhance evidence generation early in a technology's life cycle, the present paper proposes a new approach that integrates human factors and health economic evaluation as part of a wider systems approach to the design of technology. This approach (Human and Economic Resilience Design for Medical Technology or HERD MedTech) supports early stages of product development and is based on the recent experiences of the National Institute for Health Research London Diagnostic Evidence Co-operative in the UK. Expert commentary. HERD MedTech i) proposes a shift from design for usability to design for resilience, ii) aspires to reduce the need for service adaptation to technological constraints iii) ensures value of innovation at the time of product development, and iv) aims to stimulate discussion around the integration of pre- and post-market methods of assessment of medical technology.
Borsci S, Buckle P, Huddy J, et al., 2017, Usability study of pH strips for nasogastric tube placement, PLoS ONE, Vol: 12, Pages: 1-14, ISSN: 1932-6203
Aims(1) To model the process of use and usability of pH strips (2) to identify, through simulation studies, the likelihood of misreading pH strips, and to assess professional’s acceptance, trust and perceived usability of pH strips.MethodsThis study was undertaken in four phases and used a mixed method approach (an audit, a semi-structured interview, a survey and simulation study). The three months audit was of 24 patients, the semi-structured interview was performed with 19 health professionals and informed the process of use of pH strips. A survey of 134 professionals and novices explored the likelihood of misinterpreting pH strips. Standardised questionnaires were used to assess professionals perceived usability, trust and acceptance of pH strip use in a simulated study.ResultsThe audit found that in 45.7% of the cases aspiration could not be achieved, and that 54% of the NG-tube insertions required x-ray confirmation. None of those interviewed had received formal training on pH strips use. In the simulated study, participants made up to 11.15% errors in reading the strips with important implications for decision making regarding NG tube placement. No difference was identified between professionals and novices in their likelihood of misinterpreting the pH value of the strips. Whilst the overall experience of usage is poor (47.3%), health professionals gave a positive level of trust in both the interview (62.6%) and the survey (68.7%) and acceptance (interview group 65.1%, survey group 74.7%). They also reported anxiety in the use of strips (interview group 29.7%, survey group 49.7%).ConclusionsSignificant errors occur when using pH strips in a simulated study. Manufacturers should consider developing new pH strips, specifically designed for bedside use, that are more usable and less likely to be misread.
Borsci S, Buckle P, Uchegbu I, et al., 2017, Integrating human factors and health economics to inform the design of medical device: a conceptual framework, EMBEC & NBC 2017: Joint Conference of the European Medical and Biological Engineering Conference (EMBEC) and the Nordic-Baltic Conference on Biomedical Engineering and Medical Physics (NBC)
Borsci S, Buckle P, Hanna GB, 2016, Why you need to include human factors in clinical and empirical studies of in vitro point of care devices? Review and future perspectives, Expert Review of Medical Devices, Vol: 13, Pages: 405-416, ISSN: 1745-2422
Use of in-vitro point of care devices - intended as tests performed out of laboratories and near patient - is increasing in clinical environments. International standards indicate that interaction assessment should not end after the product release, yet human factors methods are frequently not included in clinical and empirical studies of these devices. Whilst the literature confirms some advantages of bed-side tests compared to those in laboratories there is a lack of knowledge of the risks associated with their use. This article provides a review of approaches applied by clinical researchers to model the use of in-vitro testing. Results suggest that only a few studies have explored human factor approaches. Furthermore, when researchers investigated people-device interaction these were predominantly limited to qualitative and not standardised approaches. The methodological failings and limitations of these studies, identified by us, demonstrate the growing need to integrate human factors methods in the medical field.
Lim RHM, Anderson JE, Buckle PW, 2015, Work domain analysis for understanding medication safety in care homes in England: an exploratory study, Ergonomics, Vol: 59, Pages: 15-26, ISSN: 1366-5847
Medication safety and errors are a major concern in care homes. In addition to the identification of incidents, there is a need for a comprehensive system description to avoid the danger of introducing interventions that have unintended consequences and are therefore unsustainable. The aim of this study was to explore the impact and uniqueness of Work Domain Analysis (WDA) to facilitate an in-depth understanding of medication safety problems within the care home system and identify the potential benefits of WDA to design safety interventions to improve medication safety. A comprehensive, systematic and contextual overview of the care home medication system was developed for the first time. The novel use of the abstraction hierarchy (AH) to analyse medication errors revealed the value of the AH to guide a comprehensive analysis of errors and generate system improvement recommendations that took into account the contextual information of the wider system.
Atkin R, Buckle P, Myerson J, 2015, Street works and vision impairment: Improving signing and guarding, Proceedings of the Institution of Civil Engineers: Municipal Engineer, Vol: 168, Pages: 11-23, ISSN: 0965-0903
A design research project was conducted in London to investigate the issues experienced by people with vision impairment around street works and to generate and evaluate improvements to the manner in which street works are signed and guarded. A qualitative, ethnographic approach was taken to achieve a multifaceted understanding of street works equipment and its operation. A small sample of pedestrians with a range of vision impairment was observed interacting with a range of street works. Participants were interviewed, using a series of prompts. Insights were gathered that informed new design requirements and decisions. A set of modifications were prototyped and tested against the existing signing and guarding system. Participants comprised 13 people with vision impairment. Extensive qualitative evidence was gathered, which supported the usefulness of the modified system, as well as a modest quantitative indication of reduced discomfort associated with the modifications.
Hignett S, Jones EL, Miller D, et al., 2015, Human factors and ergonomics and quality improvement science: integrating approaches for safety in healthcare, BMJ Quality and Safety, Vol: 24, Pages: 250-254, ISSN: 2044-5415
Hignett S, Miller D, Wolf L, et al., 2015, What is the relationship between human factors & ergonomics and quality improvement in healthcare?, Pages: 213-219
A recent initiative in the National Health Service (NHS, UK) has led to an increased interest in Human Factors & Ergonomics (HFE). As part of initial discussions there have been questions about the similarities and differences between HFE and Quality Improvement (QI).We believe that there are considerable advantages from a more structured relationship between HFE and QI in healthcare and have comparatively mapped a range of dimensions (origins, drivers, philosophy, focus, role and methods). Our conclusion is that HFE in healthcare should use four criteria to maximise the benefits from this opportunity, including the use of HFE methods to design systems, environments, products etc. and the direct involvement of qualified (chartered) HFE professionals.
Buckle P, 2015, Human factors that influence the performance of telecare, Pages: 201-204
Systems approaches and their relevance to the design and to the risk assessment of technology for telecare have been investigated. We have examined risk in five contexts namely: Assessment of telecare need and equipment provision; Installation of equipment; Review of client needs; Client use of telecare; Monitoring and Response. The results provide important areas of systems failures that have impact across the many stakeholders involved in the provision of telecare. The opportunities for improving design and are presented.
Hettinger LJ, Kirlik A, Goh YM, et al., 2015, Modelling and simulation of complex sociotechnical systems: envisioning and analysing work environments., Ergonomics, Vol: 58, Pages: 600-614
UNLABELLED: Accurate comprehension and analysis of complex sociotechnical systems is a daunting task. Empirically examining, or simply envisioning the structure and behaviour of such systems challenges traditional analytic and experimental approaches as well as our everyday cognitive capabilities. Computer-based models and simulations afford potentially useful means of accomplishing sociotechnical system design and analysis objectives. From a design perspective, they can provide a basis for a common mental model among stakeholders, thereby facilitating accurate comprehension of factors impacting system performance and potential effects of system modifications. From a research perspective, models and simulations afford the means to study aspects of sociotechnical system design and operation, including the potential impact of modifications to structural and dynamic system properties, in ways not feasible with traditional experimental approaches. This paper describes issues involved in the design and use of such models and simulations and describes a proposed path forward to their development and implementation. PRACTITIONER SUMMARY: The size and complexity of real-world sociotechnical systems can present significant barriers to their design, comprehension and empirical analysis. This article describes the potential advantages of computer-based models and simulations for understanding factors that impact sociotechnical system design and operation, particularly with respect to process and occupational safety.
Hignett S, Carayon P, Buckle P, et al., 2013, State of science: human factors and ergonomics in healthcare, ERGONOMICS, Vol: 56, Pages: 1491-1503, ISSN: 0014-0139
Flin R, Bromiley M, Buckle P, et al., 2013, MID STAFFS INQUIRY Changing behaviour with a human factors approach, BMJ-BRITISH MEDICAL JOURNAL, Vol: 346, ISSN: 1756-1833
Anderson O, Carr R, Briggs M, et al., 2012, Human gastric lipase augmentation of nasogastric tube aspirate pH tests (oral presentation), London Deanery South-East Thames Surgical Research Symposium, Maidstone, UK
Anderson O, Buckle P, Hanna GB, 2012, Ergonomic risk assessment of nasogastric tube placement and implications for design and training (oral presentation), International Ergonomics Association 18th World Congress, Recife, Brazil
Anderson O, Carr R, Briggs M, et al., 2012, Human gastric lipase augmentation of nasogastric tube aspirate pH tests (oral presentation), Society of Academic & Research Surgery (SARS)
Dul J, Bruder R, Buckle P, et al., 2012, A strategy for human factors/ergonomics: developing the discipline and profession, ERGONOMICS, Vol: 55, Pages: 377-395, ISSN: 0014-0139
Buckle P, 2012, Systems approaches to risk assessing healthcare, how far have we come?, WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION, Vol: 41, Pages: 3847-3849, ISSN: 1051-9815
Buckle P, Buckle J, 2012, OBESITY AND ERGONOMICS, International Conference on Contemporary Ergonomics and Human Factors, Publisher: CRC PRESS-TAYLOR & FRANCIS GROUP, Pages: 169-170
Anderson O, Buckle P, Hanna G, 2012, Ergonomic risk assessment of nasogastric tube placement and implications for design and training, WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION, Vol: 41, Pages: 4689-4691, ISSN: 1051-9815
Shepherd T, Buckle P, 2012, Older nurses and physical work: the perceptions of back care advisers, Column, Vol: 24, Pages: 16-25
Anderson O, Carr R, Briggs M, et al., 2012, Human gastric lipase augmentation of nasogastric tube aspirate pH tests (abstract), Br J Surg, Vol: 99 (Suppl. 4)
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