Search

BackgroundA novel medical device has been developed to address an unmet need in standardising and facilitating heart rate recording during neonatal resuscitation. In a time critical emergency resuscitation, where failure can mean death of an infant, it is vital that clinicians are provided with information in a timely, precise and clear manner to capacitate appropriate decision making. This new technology provides a hands free, wireless heart rate monitoring solution that easily fits the clinical pathway and procedure for neonatal resuscutation.To understand the requirements of the interface design for this new device, a human factors approach was implemented. This combined a traditional user-centred design approach with an Applied Cognititive Task Analysis (ACTA) to understand the tasks involved, the cognitive requirements and the potential for error during a neonatal resusciation scenario.MethodFourteen clinical staff were involved in producing the final design requirements. Two paediatric doctors supported the development of a visual representation of the activities associated with neonatal resucitation. This was used to develop a scenario based workshop. Two workshops were carried out in parallel and involved three paediatric doctors, three neonatal nurses, two advance neonatal practitioners and four midwives. Both groups came together at the end to reflect on the findings which emerged during the separate sessions.ResultsThe outputs of this study have provided a comprehensive description of information requirements during neonatal resuscitation, and enabled product developers to understand the preferred requirements of the user interface design for the device. The study raised three key areas for the designers to consider, which had not previously been highlighted. These related to: 1) interface layout and information priority - heart rate should be central and occupy two thirds of the screen, device, 2) size and portability – to enable positioning local to baby’s head and allow visibility from all angles and 3) auditory feedback - to support visual information on heart rate rhythm and reliability of the trace with an early alert for intervention, whilst avoiding parental distress.ConclusionThis study demonstrates the application of human factors and the ACTA method, which identified user requirements previously not identified. This methodology provides a useful approach to aid development of the clinical interface for medical devices.

Stereotactic Ablative Radiotherapy (SABR) and percutaneous microwave ablation (PMWA) are now being performed in patients deemed “medically inoperable” with non-small cell lung cancer (NSCLC). The majority of these patients are treated without ground truth histology, relying on imaging to establish the diagnosis. The purpose of this study was to investigate whether there were differences in the visible imaging features including CT Texture Analysis (CTTA) between patients referred for surgery, SABR and PMWA, which might suggest differences in underlying diagnosis.

The BTS Pulmonary Nodule Guidelines recommend the use of nodule volumetry as a biomarker of malignancy in pulmonary nodules (PNs). However, studies have shown that there is significant inter-scan variability of such volume measurements, which can vary by up to 25% (Gietema et al 2007). CT Texture analysis (CTTA) has also been shown to be a potential imaging biomarker of malignancy but requires further validation.

Since 2000 the Serious Hazards of Transfusion (SHOT) Organisation indicates 50% of all near misses occur at the blood sampling phase (PHB Bolton-Maggs et al 2014). In particular these data raise concerns for the stages of patient identification and the labelling of samples. The Health and Safety Executive (HSE 2009) highlights that 'proper' consideration of Human Factors is necessary for effective health and safety management of an organisation. This approach is adopted by other safety critical industries and actively encouraged by the recent NHS Concordat (NQB 2014), and deemed relevant to blood sampling (Murphy and Kay 2004), however, yet to be fully embraced within healthcare A pilot study was undertaken by the University of Nottingham, for NHS Scotland and NES to understand why variability exists in patient identification and labelling of blood samples. The aim of this work was to evaluate 'work as done' rather than 'perceived to be done' and to identify factors contributing to the variability of work practices in the context of: clinical departments, working environments and organisational goals. The study adopted a qualitative approach and was completed in four Scottish hospitals; undertaking observations (n = 50) and interviews (n = 15) with a review of local incident data. The data was used to inform the Functional Resonance Analysis Method - FRAM (Hollnagel 2012). This method models the interactions between the functions relevant to blood sampling and the potential variability in performance. The output from this method is a visual and descriptive representation of the system, which assists in focusing safety management activities to dampen down unwanted variability. The findings suggest that the technology to provide information, request a blood sample and provide labels prior to blood sampling were heavily influential to the reliability of obtaining a minimal data set and patient details. The accessibility, location and reliability of technology or its timely repair influenced how practitioners modified their work to minimise delay in obtaining a sample and manage workload associated with a high volume of patients. The working contexts i.e. emergency departments, outpatients, influenced how blood sampling functions were organised; to balance clinical and safety goals in the context of organisational targets. Variability was discovered in the number of practitioners involved in a single blood sampling process and environmental factors that influenced practitioners work practices to mitigate the impact of common distractions and delays. The ratio of staff to patients and skill mix within a working environment had implications for the time pressure and accuracy of some blood sampling functions. The writing surface of the label on a group and save sample was also identified as a contributing factor for the accuracy of sample labelling. The FRAM model has enabled the visualisation of critical blood sampling functions to illustrate how constraints or a lack of resources can impact on the variability of the outcome. This study illustrates how variability in the practitioner's work practices seeks to balance a trade-off between efficiency and thoroughness in order to achieve the required level of performance.