A Combined Assessment Tool of Teamwork, Communication, and Workload in Hospital Procedural Units.

Teamwork, communication, and workload issues continue to contribute to patient safety events. The authors developed a diagnostic mixed methods toolkit combining a behavior observation tool, semistructured interview guide, and surveys to proactively identify relevant gaps. Applied across 14 units at three hospitals, this toolkit yielded 344 findings with 156 associated recommendations and took, on average, four days of observation. On a scale from 1 (not at all helpful) to 6 (substantially helpful), leaders indicated that the assessment and its recommendations were very helpful (median 5, interquartile range 5-6, 34 survey respondents, 47.9% individual-level response rate, 85.7% unit-level response rate). Integrating this tool into a broader safety strategy can help inform organizational improvement efforts.

Connecting pathogen transmission and healthcare worker cognition: a cognitive task analysis of infection prevention and control practices during simulated patient care.

BACKGROUND: Relatively little is known about the cognitive processes of healthcare workers that mediate between performance-shaping factors (eg, workload, time pressure) and adherence to infection prevention and control (IPC) practices. We taxonomised the cognitive work involved in IPC practices and assessed its role in how pathogens spread. METHODS: Forty-two registered nurses performed patient care tasks in a standardised high-fidelity simulation. Afterwards, participants watched a video of their simulation and described what they were thinking, which we analysed to obtain frequencies of macrocognitive functions (MCFs) in the context of different IPC practices. Performance in the simulation was the frequency at which participants spread harmless surrogates for pathogens (bacteriophages). Using a tertiary split, participants were categorised into a performance group: high, medium or low. To identify associations between the three variables-performance groups, MCFs and IPC practices-we used multiblock discriminant correspondence analysis (MUDICA). RESULTS: MUDICA extracted two factors discriminating between performance groups. Factor 1 captured differences between high and medium performers. High performers monitored the situation for contamination events and mitigated risks by applying formal and informal rules or managing their uncertainty, particularly for sterile technique and cleaning. Medium performers engaged more in future-oriented cognition, anticipating contamination events and planning their workflow, across many IPC practices. Factor 2 distinguished the low performers from the medium and high performers who mitigated risks with informal rules and sacrificed IPC practices when managing tradeoffs, all in the context of minimising cross-contamination from physical touch. CONCLUSIONS: To reduce pathogen transmission, new approaches to training IPC (eg, cognitive skills training) and system design are needed. Interventions should help nurses apply their knowledge of IPC fluidly during patient care, prioritising and monitoring situations for risks and deciding how to mitigate risks. Planning IPC into one's workflow is beneficial but may not account for the unpredictability of patient care.

Factors That Affect Drivers' Perception of Closing and an Immediate Hazard.

OBJECTIVE: To measure the looming threshold for when drivers perceive closing and an immediate hazard and determine what factors affect these thresholds. BACKGROUND: Rear-end collisions are a common type of crash. One key issue is determining when drivers first perceive they need to react. The looming threshold for closing and an immediate hazard are critical perceptual thresholds that reflect when drivers perceive they need to react. METHOD: Two driving simulator experiments examined whether engaging in a cell phone conversation and whether the complexity of the roadway environment affect these thresholds for the perception of closing and immediate hazard. Half of the participants engaged in a cognitive task, the last letter task, to emulate a cell phone conversation, and all participants experienced both simple and complex roadway environments. RESULTS: Drivers perceived an immediate hazard later when engaged in a cell phone conversation than when not engaged in a conversation but only when the driving task was relatively less demanding (e.g., simple roadway, slow closing velocity). Compared to simple scenes, drivers perceived closing and an immediate hazard later for complex scenes but only when closing velocity was 30 mph (48.28 km/h) or greater. CONCLUSION: Cell phone conversation can affect when drivers perceive an immediate hazard when the roadway is less demanding. Roadway complexity can affect when drivers perceive closing and an immediate hazard when closing velocity is high. APPLICATION: Results can aid accident analysis cases and the design of driving automation systems by suggesting when a typical driver would respond.

A Systematic Review and Meta-Analysis of Takeover Performance During Conditionally Automated Driving.

OBJECTIVE: The aim of this paper was to synthesize the experimental research on factors that affect takeover performance during conditionally automated driving. BACKGROUND: For conditionally automated driving, the automated driving system (ADS) can handle the entire dynamic driving task but only for limited domains. When the system reaches a limit, the driver is responsible for taking over vehicle control, which may be affected by how much time they are provided to take over, what they were doing prior to the takeover, or the type of information provided to them during the takeover. METHOD: Out of 8446 articles identified by a systematic literature search, 48 articles containing 51 experiments were included in the meta-analysis. Coded independent variables were time budget, non-driving related task engagement and resource demands, and information support during the takeover. Coded dependent variables were takeover timing and quality measures. RESULTS: Engaging in non-driving related tasks results in degraded takeover performance, particularly if it has overlapping resource demands with the driving task. Weak evidence suggests takeover performance is impaired with shorter time budgets. Current implementations of information support did not affect takeover performance. CONCLUSION: Future research and implementation should focus on providing the driver more time to take over while automation is active and should further explore information support. APPLICATION: The results of the current paper indicate the need for the development and deployment of vehicle-to-everything (V2X) services and driver monitoring.