Jeffrey Taekman

Problems with communication and team coordination are frequently linked to adverse events in medicine. However, there is little experimental evidence to support a relationship between observer ratings of teamwork skills and objective measures of clinical performance. Our main objective was to test the hypothesis that observer ratings of team skill will correlate with objective measures of clinical performance. Nine teams of medical students were videotaped performing two types of teamwork tasks: (1) low fidelity classroom-based patient assessment and (2) high fidelity simulated emergent care. Observers used a behaviourally anchored rating scale to rate each individual on skills representative of assertiveness, decision-making, situation assessment, leadership, and communication. A checklist-based measure was used to assess clinical team performance. Moderate to high inter-observer correlations and moderate correlations between cases established the validity of a behaviourally anchored team skill rating tool for simulated emergent care. There was moderate to high correlation between observer ratings of team skill and checklist-based measures of team performance for the simulated emergent care cases (r = 0.65, p = 0.06 and r = 0.97, p < 0.0001). These results provide prospective evidence of a positive relationship between observer ratings of team skills and clinical team performance in a simulated dynamic health care task.

I. HUMAN PATIENT SIMULATORS uman patient simulators used in the anesthesiology domain are life-size mannequins that imitate human physiological function. They have vital signs (as displayed in patient monitors) and fully integrated cardiovascular and respiratory systems. ...

Abstract—We argue that a critical component of designing comprehensible intelligent systems is finding the right applications for intelligence and designing intelligent solutions toward those applications. While we do not refute the value of good attention to later stages of human-...

I. HUMAN PATIENT SIMULATORS uman patient simulators used in the anesthesiology domain are life-size mannequins that imitate human physiological function. They have vital signs (as displayed in patient monitors) and fully integrated cardiovascular and respiratory systems. ...

ABSTRACT As capabilities for storing and sharing electronic health data expand, it becomes increasingly important to classify, prioritize, and contextually link patient health data. Providers using electronic health records (EHR) complain that it is difficult for them to rapidly find information they need and that key information can be missed. Unfortunately, phases of human-centered design that support defining information needs and developing an understanding of the work environment are sometimes shortchanged. We present a knowledge elicitation approach for the purposes of supporting EHR design that combines the rich contextual data gained through recording information use activities during actual patient care followed by retrospective verbal protocol interviews of the provider as they watch and listen to playback of their information use activities. As a means of analyzing qualitative data collected through techniques such as these, we apply grounded theory based content analysis techniques. The goal of our research is the development of principles to support better organization and prioritization in the presentation of electronic health data. As a secondary objective, we also seek to identify criteria that, with computational algorithms, may be used to prioritize specific data in context to support intelligent contextualized information display. In this paper, we present details of our methods (data collection and analyses), preliminary findings that have resulted from these efforts, and specific advantages and disadvantages to our approach.

Eye tracking can be a valuable tool for collecting data about perception and attention in task performance, but its use in human factors research has been limited. This may be due to the fact that the coding and visualization of eye tracking data can be difficult and time-...

The authors developed a Standardized Assessment for Evaluation of Team Skills (SAFE-TeamS) in which actors portray health care team members in simulated challenging teamwork scenarios. Participants are scored on scenario-specific ideal behaviors associated with assistance, conflict resolution, communication, assertion, and situation assessment. This research sought to provide evidence of the validity and feasibility of SAFE-TeamS as a tool to support the advancement of science related to team skills training. Thirty-eight medical and nursing students were assessed using SAFE-TeamS before and after team skills training. The SAFE-TeamS pretraining and posttraining scores were compared, and participants were surveyed. Generalizability analysis was used to estimate the variance in scores associated with the following: examinee, scenario, rater, pretraining/posttraining, examinee type, rater type (actor-live vs. external rater-videotape), actor team, and scenario order. The SAFE-TeamS scores reflected improvement after training and were sensitive to individual differences. Score variance due to rater was low. Variance due to scenario was moderate. Estimates of relative reliability for 2 raters and 8 scenarios ranged from 0.6 to 0.7. With fixed scenarios and raters, 2 raters and 2 scenarios, reliability is greater than 0.8. Raters believed SAFE-TeamS assessed relevant team skills. Examinees' responses were mixed. The SAFE-TeamS was sensitive to individual differences and team skill training, providing evidence for validity. It is not clear whether different scenarios measure different skills and whether the scenarios cover the necessary breadth of skills. Use of multiple scenarios will support assessment across a broader range of skills. Future research is required to determine whether assessments using SAFE-TeamS will translate to performance in clinical practice.

Eye tracking can be a valuable tool for collecting data about perception and attention in task performance, but its use in human factors research has been limited. This may be due to the fact that the coding and visualization of eye tracking data can be difficult and time-...

ABSTRACT Introduction/Background: Over 370,000 cardiopulmonary resuscitations are attempted each year in US hospitals.1 For many, pulseless ventricular tachycardia or ventricular fibrillation (VT/VF) is the first monitored arrhythmia, which may be treated successfully with prompt defibrillation. Yet for 30% of patients, defibrillation is delayed more than 2 minutes, reducing their chance of survival to hospital discharge by half.2 To increase the potential for timely detection of cardiac events, many at-risk patients are monitored by telemetry technicians. However, decisions regarding the appropriate number of patients that a single technician may safely and effectively monitor are primarily based on technological capabilities and not on our understanding of human information processing limitations. Simulation provides an opportunity to measure responses to life-threatening cardio-respiratory events in a time frame and with a degree of accuracy not feasible through assessment of response to true events. Our objective is to determine the impact of increasing the number of patients monitored on response time to cardio-respiratory events. To achieve this objective, we designed simulation of cardiac telemetry monitoring Methods: Currently, we are carrying out a randomized controlled trial to compare response times to VF across five number-of-patient conditions. The simulation replicates the work of cardiac telemetry technicians using a combination of real patient data and a simulated patient experiencing VF. We video and audio-recorded true patient data with a single simulated patient embedded in the patient set. The technical implementation involved connecting an ECG rhythm simulator into the hospital's network that transmits physiological signals to remote telemetry monitors. The signal appears in exactly the same way as it would appear for a real patient. Study participants are randomly assigned to one of the 5 patient loads and complete a four-hour monitoring session, during which they perform tasks similar to real monitoring work, such as calling patients' providers to report events and documenting changes. After about 3 hours, the simulated patient sustains VF and the time required for the participants to report this arrhythmia is recorded. Study participants are asked to complete a survey regarding the realism of the simulation. 28 technicians and nurses from cardiac units have completed the study to date. As expected, there is a trend of increasing response time to the lethal arrhythmia as the number of patients monitored increases. Survey Results are presented in the Table. Results: Conclusion: We simulated the work of remote cardiac telemetry technicians to study the effect of increasing the number of patients monitored on response time to a simulated arrhythmia. Overall, study participants perceived the experience to be relatively realistic. The knowledge to be gained will inform efforts to study this problem in real-world cardiac telemetry. References: 1. Ballew KA, Philbrick JT. Causes of variation in reported in-hospital CPR survival: A critical review. Resuscitation 1995;30:203-15. 2. Chan PS, Krumholz HM, Nichol G, Nallamothu BK. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 2008;358:9-17. Disclosures: Abbott, Pfizer Guidepoint, Maven Applied Research Associates-proprietary interest in jointly developed projects BMS, Pfizer, The Medicines Company, Merck, Novartis, Medtronic, Boehringer Ingelheim, Astra Zeneca BMS, Pfizer, The Medicines Company, Boehringer Ingelheim, Daiitchi, Astra Zeneca.

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