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OBJECTIVE: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD: We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS: Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION: Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

Designing health IT aimed at supporting team-based care and improving patient safety is difficult. This requires a work system (i.e., SEIPS) evaluation of the technology by care team members. This study aimed to identify work system barriers and facilitators to the use of a team health IT that supports care transitions for pediatric trauma patients. We conducted an analysis on 36 interviews - representing 12 roles - collected from a scenario-based evaluation of T3. We identified eight dimensions with both barriers and facilitators in all five work system elements: person (experience), task (task performance, workload/efficiency), technology (usability, specific features of T3), environment (space, location), and organization (communication/coordination). Designing technology that meets every roles needs is challenging; in particular, when trade-offs need to be managed, e.g., additional workload for one role or divergent perspectives regarding specific features. Our results confirm the usefulness of a continuous work system approach to technology design and implementation.

We need to design technologies that support the work of health care teams; designing such solutions should integrate different clinical roles. However, we know little about the actual collaboration that occurs in the design process for a team-based care solution. This study examines how multiple perspectives were managed in the design of a team health IT solution aimed at supporting clinician information needs during pediatric trauma care transitions. We focused our analysis on four co-design sessions that involved multiple clinicians caring for pediatric trauma patients. We analyzed design session transcripts using content analysis and process coding guided by Détiennes (2006) co-design framework. We expanded upon Détienne (2006) three collaborative activities to identify specific themes and processes of collaboration between care team members engaged in the design process. The themes and processes describe how team members collaborated in a team health IT design process that resulted in a highly usable technology.

BackgroundDiagnostic errors are an underappreciated cause of preventable mortality in hospitals and pose a risk for severe patient harm and increase hospital length of stay. ObjectiveThis study aims to explore the potential of machine learning and natural language processing techniques in improving diagnostic safety surveillance. We conducted a rigorous evaluation of the feasibility and potential to use electronic health records clinical notes and existing case review data. MethodsSafety Learning System case review data from 1 large health system composed of 10 hospitals in the mid-Atlantic region of the United States from February 2016 to September 2021 were analyzed. The case review outcome included opportunities for improvement including diagnostic opportunities for improvement. To supplement case review data, electronic health record clinical notes were extracted and analyzed. A simple logistic regression model along with 3 forms of logistic regression models (ie, Least Absolute Shrinkage and Selection Operator, Ridge, and Elastic Net) with regularization functions was trained on this data to compare classification performances in classifying patients who experienced diagnostic errors during hospitalization. Further, statistical tests were conducted to find significant differences between female and male patients who experienced diagnostic errors. ResultsIn total, 126 (7.4%) patients (of 1704) had been identified by case reviewers as having experienced at least 1 diagnostic error. Patients who had experienced diagnostic error were grouped by sex: 59 (7.1%) of the 830 women and 67 (7.7%) of the 874 men. Among the patients who experienced a diagnostic error, female patients were older (median 72, IQR 66-80 vs median 67, IQR 57-76; P=.02), had higher rates of being admitted through general or internal medicine (69.5% vs 47.8%; P=.01), lower rates of cardiovascular-related admitted diagnosis (11.9% vs 28.4%; P=.02), and lower rates of being admitted through neurology department (2.3% vs 13.4%; P=.04). The Ridge model achieved the highest area under the receiver operating characteristic curve (0.885), specificity (0.797), positive predictive value (PPV; 0.24), and F1-score (0.369) in classifying patients who were at higher risk of diagnostic errors among hospitalized patients. ConclusionsOur findings demonstrate that natural language processing can be a potential solution to more effectively identifying and selecting potential diagnostic error cases for review and therefore reducing the case review burden.

BACKGROUND: As problems of acceptance, usability and workflow integration continue to emerge with health information technologies (IT), it is critical to incorporate human factors and ergonomics (HFE) methods and design principles. Human-centered design (HCD) provides an approach to integrate HFE and produce usable technologies. However, HCD has been rarely used for designing team health IT, even though team-based care is expanding. OBJECTIVE: To describe the HCD process used to develop a usable team health IT (T3 or Teamwork Transition Technology) that provides cognitive support to pediatric trauma care teams during transitions from the emergency department to the operating room and the pediatric intensive care unit. METHODS: The HCD process included seven steps in three phases of analysis, design activities and feedback. RESULTS: The HCD process involved multiple perspectives and clinical roles that were engaged in inter-related activities, leading to design requirements, i.e., goals for the technology, a set of 47 information elements, and a list of HFE design principles applied to T3. Results of the evaluation showed a high usability score for T3. CONCLUSIONS: HFE can be integrated in the HCD process through a range of methods and design principles. That design process can produce a usable technology that provides cognitive support to a large diverse team involved in pediatric trauma care transitions. Future research should continue to focus on HFE-based design of team health IT.

BACKGROUND: Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of childrens death. Trauma care by its very nature is team based but due to the emergent nature of trauma, critical clinical information is often missed in the transition of these patients from one service or unit to another. Teamwork transition technology can help support these transitions and minimize information loss while enhancing information gathering and storage. In this study, we created a large screen technology to support shared situational awareness across multiple clinical roles and departments. OBJECTIVES: This study aimed to examine if the Teamwork Transition Technology (T3) supports teams and team cognition. METHODS: We used a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T3. RESULTS: Results of the evaluation show that most participants agreed that the technology helps achieve the goals set out in the design phase. Respondents thought that T3 organizes and presents information in a different way that was helpful to them. CONCLUSION: In this study, we examined a health IT (T3) that was designed to support teams and team cognition. The results of our evaluation show that participants agreed that T3 does support them in their work and increases their situation awareness.

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.

Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Every year, nearly 10 million children are evaluated in emergency departments (EDs) for traumatic injuries, resulting in 250,000 hospital admissions and 10,000 deaths. Pediatric trauma care in hospitals is distributed across time and space, and particularly complex with involvement of large and fluid care teams. Several clinical teams (including emergency medicine, surgery, anesthesiology, and pediatric critical care) converge to help support trauma care in the ED; this co-location in the ED can help to support communication, coordination and cooperation of team members. The most severe trauma cases often need surgery in the operating room (OR) and are admitted to the pediatric intensive care unit (PICU). These care transitions in pediatric trauma can result in loss of information or transfer of incorrect information, which can negatively affect the care a child will receive. In this study, we interviewed 18 clinicians about communication and coordination during pediatric trauma care transitions between the ED, OR and PICU. After the interview was completed, we surveyed them about patient safety during these transitions. Results of our study show that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To safely manage the transition of this fragile and complex population, we need to find ways to better manage the information flow during these transitions by, for instance, providing technological support to ensure shared mental models.

Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e. safety in complex systems. We discuss three levels of awareness (individual, team and organizational) and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration and decision making. A challenge to team awareness is inadequate non-technical skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, by using process modeling or simulation.

OBJECTIVE: To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. METHODS: We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospitals PL etiquette document of guideline. RESULTS: We identified five goals of the PL (to document the patients problems, to make sense of the patients problems, to make decisions about the care plan, to know who is involved in the patients care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. CONCLUSION: Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patients medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patients electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patients immediate problems.

Stimulus over-selectivity is said to have occurred when only a limited subset of the total number of stimuli present during discrimination learning controls behavior, thus, restricting learning about the range, breadth, or all features of a stimulus. The current study investigated over-selectivity of 100 typically developing children, aged 3-7 (mean = 65.50 ± 17.31 SD months), using a visual discrimination task. Developmental trends in over-selectivity and their relationship to some cognitive variables (i.e., selective attention, sustained attention, and cognitive flexibility) were the target. Over-selectivity decreased with age, but this effect was mediated by the development of cognitive flexibility. Over-selectivity increased when a distractor task was introduced, which was not mediated by the other cognitive variables under investigation. The current results assist in the establishment of the theoretical underpinnings of over-selectivity by offering evidence of its underlying determinants and relating these to developmental trends.

Research methods papers are a valuable resource to researchers and clinicians that highlight novel yet effective methodologies and approaches to conducting research. Clinicians can use the knowledge generated from unique research methods to conduct quality, evidence-based practice, and quality improvement projects, and nurse researchers can benefit from the lessons learned by others to improve the rigor of future studies. This paper defines research methods papers, provides an overview of their importance, including examples from the literature, and highlights important considerations when writing and disseminating the findings of research methods. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate ambulatory-care sensitive (ACS) hospitalizations for children with noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC), and identify associations with ambulatory care characteristics. Although ACS hospitalizations are potentially preventable in general populations, the specific ambulatory care predictors and influence of medical complexity on them is poorly understood.Study designRetrospective cohort study of NC-CD and CMC hospitalizations at a children's hospital during 2007-2014, excluding labor/delivery and children over 21 years. Pediatric medical complexity algorithm identified NC-CD or CMC. ACS hospitalizations were identified using Agency for Healthcare Research and Quality indicator definitions. Demographic and ambulatory care characteristics were compared between ACS and non-ACS hospitalizations with logistic regression clustered by patient. Measures of ambulatory care during 2 years before admission were explored with 20% random sample of general pediatrics discharges.ResultsAmong 4035 children with NC-CD, 14.6% of 4926 hospitalizations were ACS hospitalizations. Among 5084 CMC, 5.3% of 14 390 discharges were ACS hospitalizations. Among NC-CD discharges, ACS hospitalizations were more likely with no prior-year outpatient visits (OR 1.4, 95% CI 1.1-1.7) and less likely with timely well checks (OR 0.8, 95% CI 0.6-0.9) and phone encounters in the month before admission (OR 0.5, 95% CI 0.2-1.0). Among CMC discharges, the only association observed was with provider continuity (OR 0.3, 95% CI 0.1- 1.0).ConclusionsProvider continuity may be associated with fewer CMC ACS hospitalizations, however, measures of ambulatory care were more consistently associated with ACS hospitalizations for NC-CD. CMC may need more precise ACS hospitalization definitions.

Secondary data analysis is a cost-effective, accessible, and efficient means of utilizing existing data to answer new research questions. The manuscript provides an overview of the secondary data analysis process, as well as benefits and limitations inherent in the research method. An exemplar of pediatric focused research using a publicly available dataset is presented to facilitate understanding of the process. Novice and experienced researchers benefit from exploring the quantitative and qualitative secondary data analysis options available. [ABSTRACT FROM AUTHOR]

Parents, who were working as essential frontline healthcare workers experienced unique stressors during the COVID-19 pandemic including disruption of regular routines, long lapses away from family, extreme work stress and subsequent difficulty in compartmentalizing work-related concerns when at home. The purpose of this study was to assess COVID-19 exposure and impact of frontline healthcare workers who are parents. This study quantitatively assessed the COVID-19 exposure and impact and qualitatively explored perceptions of parents of children 9 to 17 years of age, who were also frontline healthcare workers. Participants (N = 79) using the COVID-19 Exposure and Family Impact Survey (CEFIS) reported exposure mean scores of 10.03 (SD = 2.63); and impact scores mean scores of 3.18 (SD = 0.46). Thematic analysis identified four themes, each with 2 subthemes: 1) family stressors increased (e.g., concerns about health and safety, losses of lifestyle patterns); 2) changes in children's health and well-being (e.g., isolation from family and friends, mental health problems); 3) virtual school difficulties (e.g., parent and student challenges, home school option); 4) skill building opportunities (e.g., enhanced emotional connections, increased family activities). The CHAMPS Family Health Study suggests that families of essential workers are especially vulnerable to the effect of COVID-19, as are those families of essential workers who include child/ren with special health care needs. Preparation for future emergencies requires strategies to mitigate consequences and promote well-being. These results highlight the need for supportive approaches to decrease the negative consequences of stress and to augment skills for family connection and cooperation. • Numerous challenges were experienced by parents who were frontline healthcare workers during the COVID-19 pandemic. • Parents with shared custody of their children voluntarily waived visitation to protect the children from the COVID virus. • Preparation for future emergencies requires resources, support systems, and focused strategies to manage family problems. [ABSTRACT FROM AUTHOR]

Whilst some form of ostracism is experienced by most people at some point in their lives, it is experienced far more often in individuals with Autism Spectrum Disorder (ASD). Little is known about how this social exclusion is interpreted, experienced or managed. This study aimed to explore the psychological (mood and social needs) as well as the physiological (arousal) effects of ostracism using a well-established paradigm, Cyberball. Results demonstrated no differences between groups on social needs, however, mood was rated as more negatively by ASDs overall. Arousal was increased in when excluded compared with when excluded for ASDs, but not for controls. Overall, individuals with ASD experienced heightened physiological arousal but whilst these individuals reported overall lower mood, this response to ostracism was not expressed as emotionally significant to these individuals, suggesting possible interoceptive difficulties in this population. This highlights the need for both understanding in non-ASD individuals and intervention of this emotional distress in individuals with ASD.

In 2021, federal guidelines mandated that health-care organizations share clinicians' notes with patients to increase information transparency. While findings indicate advantages for adult patients, less is known about note-sharing from the viewpoint of adolescents. This study aims to identify adolescent, parent, and clinician perspectives on the anticipated benefits and concerns of giving adolescents access to clinicians' notes and strategies to support note-sharing in this population. We conducted six focus groups with adolescents, parents, and clinicians at a children's hospital from May to October 2021. A semistructured facilitator guide captured participant perspectives of note-sharing benefits, concerns, and strategies. Two researchers independently coded and analyzed transcript data using thematic analysis; a third researcher reconciled discrepancies. 38 stakeholders (17 adolescents, 10 parents, and 11 clinicians) described four benefits, three concerns, and four implementation strategies regarding adolescent note-sharing. Potential benefits included adolescents using notes to remember and reinforce the visit, gaining knowledge about their health, strengthening the adolescent-clinician relationship, and increasing agency in health care decisions. Concerns included notes leading to a breach in confidentiality, causing negative emotions, and becoming less useful for clinicians. Strategies included making note-sharing more secure, optimizing note layout and content, setting clear expectations, and having a portion of the note for clinician use only. Stakeholders suggest multiple strategies to optimize the implementation of note-sharing to support adolescent patients, parents, and clinicians as hospitals work to comply with federal regulations. These strategies may reinforce the potential benefits and mitigate the challenges of sharing notes with adolescent patients. [ABSTRACT FROM AUTHOR]

This essay1 revisits J. M. Coetzee's representation of Friday's body in his 1986 novel Foe in the context of his long-standing interest in the idea of grace. Through a reading of Friday's dancing in Foe, I argue that Coetzee's representation of Friday consistently invokes grace as a physical and aesthetic concept, rather than the theological emphasis that has prevailed in critical discussions to date. The reading is amplified by evidence from the Coetzee Papers at the Harry Ransom Center, which points towards Coetzee's engagement in the early 1980s with the work of German writer Heinrich von Kleist and his 'On the Puppet Theatre'. I draw on contemporary scholarship that revisits aesthetic theory, the backdrop for Kleist's dialogue, in the context of the transatlantic slave trade in order to understand the implications of Coetzee's use of the figure of the puppet and the significance of grace as an aesthetic concept for his novel. [ABSTRACT FROM AUTHOR]

Teaching of pathophysiology concepts is a core feature in health professional programs, but it can be challenging in undergraduate medical/biomedical science education, which is often highly theoretical when delivered by lectures and pen-and-paper tutorials. Authentic case studies allow students to apply their theoretical knowledge but still require good imagination on the part of the students. Lecture content can be reinforced through practical learning experiences in clinical environments. In this study, we report a new approach using clinical simulation within a Human Pathophysiology course to enable undergraduate science students to see "pathophysiology in action" in a clinical setting. Students role played health professionals, and, in these roles, they were able to interact with each other and the manikin "patient," take a medical history, perform a physical examination and consider relevant treatments. Evaluation of students' experiences suggests that using clinical simulation to deliver case studies is more effective than traditional paper-based case studies by encouraging active learning and improving the understanding of physiological concepts.

This article presents a sociomaterial account of simulation in higher education. Sociomaterial approaches change the ontological and epistemological bases for understanding learning and offer valuable tools for addressing important questions about relationships between university education and professional practices. Simulation has grown in many disciplines as a means to bring the two closer together. However, the theoretical underpinnings of simulation pedagogy are limited. This paper extends the wider work of applying sociomaterial approaches to educational phenomena, taking up Schatzki's practice theory as a distinctive basis for doing so. The question "What is being simulated?" is posed, prompting discussion of multiple bodies, performances and experiences. The potential of adopting such a framework for understanding simulation as a pedagogic practice that brings the classroom and workplace together is illustrated with reference to clinical education in nursing.

The preparation of future professionals for practice is a key focus of higher education institutions. Among a range of approaches is the use of simulation pedagogies. While simulation is often justified as a direct bridge between higher education and professional practice, this paper questions this easy assumption. It develops a conceptually driven argument to cast new light on simulation and its unarticulated potential in professional formation. The argument unfolds in, and is illustrated via, three accounts of a simulation event in an Australian undergraduate nursing program. This begins with a familiar approach, moves to one that problematizes this through a focus on disruption, culminating in a third that draws on socio-material theorisations. Here, simulation is conceived as emergent, challenging stable notions of fidelity, common in simulation literature. New possibilities of simulation in the production of agile practitioners and learners in practice are surfaced. This paper extends and enriches thinking by providing distinctive new ways of understanding simulation and the relationship it affords between education and professional practice, and by illuminating the untapped potential of simulation for producing agile practitioners.

The current experiment investigated the extent to which three variables (autism severity, nonverbal intellectual functioning, and verbal intellectual functioning) are associated with over-selective responding in a group of children with Autism Spectrum Disorder. This paper also analyzed the association of these three variables with the recovery of responding to a previously under-selected stimulus following extinction of the previously over-selected stimulus. The results demonstrated that participants showed over-selectivity, and demonstrated that extinction of the over-selected stimulus led to recovery of responding to the previously under-selected stimulus. For both over-selectivity, and recovery from over-selectivity, verbal functioning appeared to predict the effects most strongly, with greater over-selectivity in the lower functioning individuals, and greater recovery in the higher functioning individuals.