Pediatric Informatics: Computer Applications in Child Health (Health ...

90 W.H. Drummond et al.
The multidisciplinary, continuous, team-based work in intensive care units has many
commonalities with previously studied cockpit and military environments; the lessons
are of interest for redesigning health care settings as computers are installed.
HFE in avionics is the study of the interaction of pilots and crew, crews’ teamwork
and communication strategies, and the study of cockpit design and human
interaction with cockpit controls, visual dashboards, alarms, and errors (Fig. 8.4).
HFE studies the complex human–machine (computer) interactions that modern
aircraft and cockpit situations create. Changes based on the HFE have drastically
reduced errors, making flying one of the safest modes of transportation today. For
health care, many lessons can be learned from the 40-year evolution of the culture
of safety developed by the airline industry.
Battleships’ (HFE) situations that relate to team performance under stress have
been studied for a century. In the closed and isolated battleship environment,
perfect teamwork of the militarily trained crew is imperative, driven by need for
instantaneous coordinated response during attack and defense actions. Military
HFE research includes the impact of noise, sleep deprivation, severe psychological
stress, need for both acoustic and visual communication strategies, as well as coordinating
human emergency responses in situations of life threatening uncertainty
that occur intermittently and unexpectedly.
For those familiar with health care, the comparison between battleship situations
and the ICU or emergency department in modern hospitals is obvious, suggesting
that HFE lessons learned from battleship environments may be important in hospital
settings.
Specific HFE research regarding appropriate designs for ICU workspaces,
machines, and workflow is in its infancy, especially for the newborn and pediatric
intensive care units (PICU). An extensive literature search (by WHD) in 2007
found no articles that are pertinent to the Human Factors problems in NICU or
PICUs, except those mentioned in the second case study (Scenario B).
General lessons can be transferred to health care environments from HFE research
in avionics (pilots, teamwork, cockpit physical design, alarms, and error signals),
and in battleships (physical spaces, extreme time pressure and need for accuracy,
teamwork despite noise, shift work, and fatigue). Corporate office HFE research contributed
information about lighting, noise, ergonomic considerations (especially in
the use of computers), financial optimization, and human responses to psychosocial
isolation in cubicles. HFE research in the safety critical areas of nuclear power plants
and air traffic control contributed understanding about alarms, alerts, information
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flow, human–machine errors and their consequences, and “latent errors.”
Unique challenges in hospital settings (not found in avionics or battleship
environments) are the steady, piecemeal addition of new treatment and monitoring
machines to ICUs of all types. These additions of machines (like a new type of
ventilator or a new “smart pump” system) that are designed to perform the same
tasks as existing equipment but may require different adaptors, training on a new
user interface, and recognition of a new set of alarms and new charting caveats, add
to the complexity of the health care environment. Further, the frequent presence of
“visitors” in the workspace, even during crisis situations may hinder providers from
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