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Biomedical subjects

F Jacob Seagull

Publications and source records attributed to F Jacob Seagull.

7 recordsLinked to original sources
PubMed2006

Emergent CSCW systems: the resolution and bandwidth of workplaces.

In any collaborative work settings, people naturally develop physical tools and associated work processes that support the management of the interdependencies in information, materials, and social needs. Field studies of management of operating rooms pointed out that collaborative work is supported by an infrastructure that is composed of mostly non-computerized, physical components. The supporting infrastructure is jointly maintained and exploited, with constantly evolving patterns of usage, in response to complexity of coordination needs and the uncertain environment. To represent status and plans, users seem to invent structures based both on idiosyncratic preferences and on negotiated symbols. The fluidity and ease of restructuring workplaces to support collaborative work may be explained in part by the high resolution and bandwidth of workplaces: a large number of ways in which workers could structure their work and a high capacity to convey rich information and meanings quickly to collaborators. We argue that to support health care workers, designers of computer supported cooperative work (CSCW) systems should learn how the physical and perceptual properties of workplaces are exploited, and that CSCW systems should be designed to allow maximum freedom of restructuring and reconfiguring as part of workplaces to enhance bandwidth and resolution of representation and communication.

Cooperative Behavior↗
PubMed2006

Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit.

BACKGROUND: In the academic trauma unit during initial evaluation and resuscitation of trauma victims, central venous catheters are often placed by multiple operators. There are few data on compliance with accepted, standard sterile practices during such procedures. METHODS: Prospective data were tabulated from video capture of 144 consecutive central venous catheterizations in a trauma resuscitation unit, during peak hours, by a team of trained video technicians. The physicians were surgical and emergency medicine residents. The number of primary operators (trainees) and secondary operators (mentors) for each line was recorded from the video analysis, as well as physician adherence to the use of maximum barrier precautions (MBP; sterile gown, gloves, full operative drape, cap, and mask). Procedures were stratified by level of urgency: Emergent (n = 7), semi-emergent (n = 20), and elective (n = 113). RESULTS: The subclavian vein was used for 73% of the elective catheter placements. For elective central venous catheters, 99 of 113 primary operators (88%) observed MBP, whereas only 31 of 45 secondary operators (69%) did so (p < or = 0.01). Among the 45 elective central venous catheters placed with a secondary operator, there were four instances of frank contamination (9%). CONCLUSIONS: Secondary operators, typically trauma surgery attendings, trauma/critical care fellows, or senior surgical residents, function as mentors in academic institutions and act as role models. Secondary operators participated in many of the studied cases, yet failed to demonstrate consistent use of MBP. In elective central venous catheter placement, those where there was the greatest opportunity to follow MBP, we observed a statistically significant difference in compliance rate between the primary and secondary operators. The study suggests the need to address the performance of the secondary operators and to educate them, as although they may be technically experienced in placing central venous catheters, they may comply less consistently with MBP.

Catheterization, Central Venous↗
PubMed2006

Video-based ergonomic analysis to evaluate thoracostomy tube placement techniques.

BACKGROUND: Thoracostomy for relief of pneumo- or hemothorax may be performed emergently at the bedside, in the emergency department or trauma area, often in nonideal circumstances. We hypothesized that ergonomic analysis of thoracostomy techniques can identify areas for potential improvement in patient and operator safety. METHODS: Interviews with Subject Matter Experts (SME) provided steps in the task of thoracostomy; 44 thoracostomies (emergent and elective) were video-recorded and reviewed by SMEs. Ergonomic analyses evaluated surgical performance techniques using video clips. RESULTS: Risks to the patient and operator included instrument-tray positioning and instrument content. Analyses of video records revealed that despite SME-survey consensus, operators inconsistently followed recommended techniques. CONCLUSIONS: Discrepancies between SME-recommended and observed practice are prevalent, with simple ergonomic problems impeding performance, and creating risks for patients and operators. Video-based ergonomic analysis is a rich source for identifying task performance problems and potential solutions.

Chest Tubes↗
PubMed2005

An algorithm for processing vital sign monitoring data to remotely identify operating room occupancy in real-time.

We developed an algorithm for processing networked vital signs (VS) to remotely identify in real-time when a patient enters and leaves a given operating room (OR). The algorithm addresses two types of mismatches between OR occupancy and VS: a patient is in the OR but no VS are available (e.g., patient is being hooked up), and no patient is in the OR but artifactual VS are present (e.g., because of staff handling of sensors). The algorithm was developed with data from 7 consecutive days (122 cases) in a 6 OR trauma center. The algorithm was then tested on data from another 7 consecutive days (98 cases), against patient in- and out-times captured by OR surveillance videos. When pulse oximetry, electrocardiogram, and temperature readings were used, OR occupancy was correctly identified 96% (95% confidence interval [CI] 95%-97%) and OR vacancy >99% of the time. Identified patient in- and out-times were accurate within 4.9 min (CI 4.2-5.7) and 2.8 min (CI 2.3-3.5), respectively, and were not different in accuracy from times reported by staff on OR records. The algorithm's usefulness was demonstrated partly by its continued operational use. We conclude that VS can be processed to accurately report OR occupancy in real-time.

Algorithms↗
PubMed2003

Coordination challenges in operating-room management: an in-depth field study.

Dynamic settings possess complex information needs all requiring attention in order to be managed effectively. The following study describes the multi-faceted information exchanges essential for an operating room suite to be managed within the context of efficient, cost effective, safe practice. Through the combined use of observation, the Critical Incident Technique, and interviews, this study analyzed information issues that impact coordination. Results demonstrate how distributed team planning is inherent to the efficacy of the system, and discuss implications for information tools to support coordination within in a complex setting.

Anesthesiology↗
PubMed2002

The hostile environment of the intensive care unit.

Intensive care units (ICUs) were developed for patients with special needs and include an array of technology to support medical care. However, basic lessons in ergonomics, human factors, and human performance fail to propagate in this complex medical environment. Complicated, error-prone devices are commonly used. There are too many patient data for one person to process effectively. Lighting, ambient noise, and scheduling all result in provider and patient stress. These difficult working conditions make errors more probable and are risk factors for provider burnout and negative outcomes for patients. Auditory alarms on ICU equipment, ICU syndrome, and needle sticks are discussed as examples of such problems.

Burnout, Professional↗