Presentation
Simulating Sponge Detection: Evaluating Usability and Workflow Fit in the OR
SessionPoster Session 2
DescriptionRetained foreign objects (RFOs) occur at a rate between 1 in 1000 and 1 in 18,760 operations (Bardes & Inaba, 2017; Wan et al., 2009; Al-Qurayashi et al., 2015; Birolini, Rasslan, & Utiyama, 2016; Kaiser et al., 1996; Stawicki et al., 2013). Objects that may unintentionally be left in patients include surgical instruments, needles, and sponges (Smith, 2011; Gawande et al., 2003, Gualniera & Scurria, 2018; Bardes & Inaba, 2017; Wan et al., 2009). Technological solutions to the problem of RFOs have focused primarily on detection and accounting surgical sponges, which have been available in various forms for more than 10 years (Rupp et al., 2012; Inaba et al., 2016). There are two forms that sponge tracking technology has developed into. One type focuses on scanning sponges in and out of the sterile field, and the second type focuses on location of sponges within the operating room (OR) suite and/or patient. Both types of devices require special sponges that have radio frequency identification (RFID) tags embedded in them. Some devices combine the two forms of sponge tracking, allowing staff to be able to scan sponges in and out of the sterile field and use a location searching function in addition.
As part of a larger Patient Safety Learning Lab project that is exploring how to reduce the incidence of RFOs through a sociotechnical systems analysis, human factors, and other systems approaches, one of these sponge tracking devices was investigated. During the investigations across the three organizations involved in the work, one organization received feedback from frontline staff that they used the type of device that aided staff in finding sponges in the OR environment and patients, and appreciated its ease of use. This led to one of the other organizations pursuing to simulate the use of the device with their OR staff to identify if the device may be a better fit than other technological solutions that were implemented in the past.
METHODS
This simulation is evaluating a sponge counting device that uses RFID technology to identify if there is a sponge in the OR environment or in a patient. Participants will be scrub techs and circulating nurses, and any additional staff that are interested in participating. The simulation will be conducted in the OR, if available, or in a nearby conference room mocked up with relevant items, such as a simulated whiteboard and mayo stand. There will be a total of 15 sponges, each saturated with fake blood to enhance realism. Seven sponges will be hidden, with several placed inside simulated human abdomens, and the rest placed in a metal trash can, a full linen bad, and a trash bag.
Staff will be divided into two groups, those who receive the instructions for use for training, and those who do not. Both groups will receive a brief demonstration of how the device works prior to the beginning of the simulation. The goal is to simulate more realistic conditions under which staff might be trained “in the wild,” that is, within the actual clinical environments where they work, recognizing that formal training, routine knowledge checks, retraining, and immediate access to instructions for use are often not part of the day-to-day reality for frontline staff. Staff will then be asked to use the device to detect any missing sponges after they complete a count of the sponges on the mayo stand, while thinking aloud. The comments and thought processes that staff state while they are performing the searching tasks will be documented. Once all of the sponges are found, staff will be requested to fill out the system usability scale and provide any comments on their opinions of the device, and how it might integrate into their workflow.
ANTICIPATED RESULTS
We expect that the device we will be evaluating will be considered fairly user friendly from benchmarking at other hospital systems. We anticipate that detection times will be under three minutes for saturated sponges that are in the simulated abdomens. We expect to receive positive comments from staff from a qualitative data standpoint, as we expect that this device will line up well with frontline staff's mental model of how this type of technology will work.
OUTCOME
The results of this work will help to highlight the mental models that users may have when using sponge detection technology in the operating room, to assist with the design of new sponge counting technology. In addition, this presentation will highlight how simulation and the involvement of human factors engineers during the purchase of new hospital devices can help to determine if they are a good fit for the hospital, staff and local context. We will discuss how the results of this simulation will be used to guide purchasing and training decisions with this technology, in addition to the gaps in usability that are identified.
Our results will highlight the need for involvement for embedded human factors engineers during the device purchasing, adoption, and evaluation processes. Simulations of a device prior to purchase are a safe way to investigate difficulties in workflow and use that may not be foreseen prior to purchasing but maybe heavily impacted front line staff satisfaction, and use of technology. Simulation prior to adoption of technology can aid in ensuring technology is fit for purpose, and fits into the context of clinician's workflows in hospital environments. Determining usability and considerations for implementation prior to purchase of hospital equipment can, in turn, support patient safety and experience.
As part of a larger Patient Safety Learning Lab project that is exploring how to reduce the incidence of RFOs through a sociotechnical systems analysis, human factors, and other systems approaches, one of these sponge tracking devices was investigated. During the investigations across the three organizations involved in the work, one organization received feedback from frontline staff that they used the type of device that aided staff in finding sponges in the OR environment and patients, and appreciated its ease of use. This led to one of the other organizations pursuing to simulate the use of the device with their OR staff to identify if the device may be a better fit than other technological solutions that were implemented in the past.
METHODS
This simulation is evaluating a sponge counting device that uses RFID technology to identify if there is a sponge in the OR environment or in a patient. Participants will be scrub techs and circulating nurses, and any additional staff that are interested in participating. The simulation will be conducted in the OR, if available, or in a nearby conference room mocked up with relevant items, such as a simulated whiteboard and mayo stand. There will be a total of 15 sponges, each saturated with fake blood to enhance realism. Seven sponges will be hidden, with several placed inside simulated human abdomens, and the rest placed in a metal trash can, a full linen bad, and a trash bag.
Staff will be divided into two groups, those who receive the instructions for use for training, and those who do not. Both groups will receive a brief demonstration of how the device works prior to the beginning of the simulation. The goal is to simulate more realistic conditions under which staff might be trained “in the wild,” that is, within the actual clinical environments where they work, recognizing that formal training, routine knowledge checks, retraining, and immediate access to instructions for use are often not part of the day-to-day reality for frontline staff. Staff will then be asked to use the device to detect any missing sponges after they complete a count of the sponges on the mayo stand, while thinking aloud. The comments and thought processes that staff state while they are performing the searching tasks will be documented. Once all of the sponges are found, staff will be requested to fill out the system usability scale and provide any comments on their opinions of the device, and how it might integrate into their workflow.
ANTICIPATED RESULTS
We expect that the device we will be evaluating will be considered fairly user friendly from benchmarking at other hospital systems. We anticipate that detection times will be under three minutes for saturated sponges that are in the simulated abdomens. We expect to receive positive comments from staff from a qualitative data standpoint, as we expect that this device will line up well with frontline staff's mental model of how this type of technology will work.
OUTCOME
The results of this work will help to highlight the mental models that users may have when using sponge detection technology in the operating room, to assist with the design of new sponge counting technology. In addition, this presentation will highlight how simulation and the involvement of human factors engineers during the purchase of new hospital devices can help to determine if they are a good fit for the hospital, staff and local context. We will discuss how the results of this simulation will be used to guide purchasing and training decisions with this technology, in addition to the gaps in usability that are identified.
Our results will highlight the need for involvement for embedded human factors engineers during the device purchasing, adoption, and evaluation processes. Simulations of a device prior to purchase are a safe way to investigate difficulties in workflow and use that may not be foreseen prior to purchasing but maybe heavily impacted front line staff satisfaction, and use of technology. Simulation prior to adoption of technology can aid in ensuring technology is fit for purpose, and fits into the context of clinician's workflows in hospital environments. Determining usability and considerations for implementation prior to purchase of hospital equipment can, in turn, support patient safety and experience.
Event Type
Poster Presentation
TimeTuesday, March 244:45pm - 6:15pm EDT
LocationRhinelander Gallery
Medical and Drug Delivery Devices