This study addresses the use of order sets in the Ontario healthcare system for both diagnosis and treatment. A systematic review of the literature is combined with an analysis of the factors required to successfully implement order sets and to monitor their use and efficacy on an ongoing basis. OHTAC’s specific recommendations are included in the report.
Computed tomography (CT) is a powerful tool for the accurate and effective diagnosis and treatment of a variety of conditions because it allows high-resolution three-dimensional images to be acquired very quickly. Therefore, the use of CT has increased substantially over the past decade, resulting in growing concern over the radiation dose from CT. CT technological advances, such as the 64-slice CT scanner released in 2005, have led to new clinical CT applications that could result in further increases in patient radiation dose.
Medical applications are designed using generic software engineering methods, which often do not meet the requirements of the clinical domain, especially as related to safety and reliability. Growing evidence shows that adverse events are related to communication and coordination breakdowns, and poor application design. Thus, there is a need for new design methods tailored to the clinical domain, so that clinical applications become a safer presence in healthcare. In this respect, communication and coordination process are crucial considerations. We want to leverage knowledge about these processes to develop a design methodology that will address the special requirements of the clinical domain.
Over the past ten years, there has been a growing recognition that double-checking high-risk clinical procedures provides an important additional measure of safety. Double-checking is well established in other industries such as aviation, but is relatively new in the clinical healthcare setting. Many hospitals have adopted policies that specify independent double-checking for specific procedures, but very little time has been spent guiding healthcare clinicians on the best approach.
The implementation of health information technology in hospital Emergency Departments (ED) is changing the way healthcare is delivered and is a key component to improving quality of care. However, the beneficial impact of ehealth technology depends highly upon proper design to ensure optimal user adoption, perceived credibility, satisfaction and ease of use. The Scarborough Hospital (TSH) is conducting a pilot project which aims to enhance the quality and efficiency of their ED service by implementing two technologies: 1) A kiosk that captures data directly from patients to help clinicians monitor their changing health status, and (2) An electronic triage application that assists nurses in the assignment of patient acuity.
The objective of this project will be to demonstrate the use of vital sign capture and monitoring to enhance the effectiveness of the Ontario Critical Care Response Teams (CCRTs). This will be facilitated through the capture of vital sign data into an electronic format, applying rules and logic to this data to identify patient deterioration, and generating an automated alert to the appropriate clinician when deterioration is detected.
The Healthcare Human Factors group at the University Health Network was approached to make improvements to the patient care environment of paramedics. The present research aims to (1) understand the current workflow, challenges, and requirements associated with physical layout of the patient care area to identify possible human factors issues, and (2) develop, test and refine a redesign of the pre-hospital patient care simulator to determine its impact on workflow and safety. An additional goal is to compare adverse event reports and human factors methods to determine the relationship between the data sets.
University Health Network (UHN) recently purchased a new unit dose drug packaging machine for the Toronto General site. The new machine allows for greater flexibility in the display of information on the unit dose label. The pharmacy department wanted to format the new labels in a way that would reduce the potential for errors. The Healthcare Human Factors Group was asked to provide guidance on the general format of the labels based on principles of typography, human factors engineering, guidance documents and standards and an understanding of the workflow of all clinicians that use the information on the labels.
The British Columbia Institute of Technology wished to augment the curriculum for the Biomedical Engineering Technology program with content from the discipline of human factors engineering specifically focused on healthcare issues. An original, 13-week, online (distance learning) course was developed focusing on principles, standards, methods, and applications related to the roles of biomedical engineers and technologists.
In-room high-efficiency particulate air (HEPA) cleaners have the potential to assist in the management of airborne infectious diseases. However, this seemingly simple technology requires the cooperation of multiple stakeholders and has demanding support requirements. The Healthcare Human Factors Group compiled a sequential series of recommendations to support healthcare facilities to appropriately plan, acquire, operate and support in-room HEPA cleaners.
