Applying Human Factors Science, Design Thinking and Systems Engineering to Mitigate Threats to Neonates Undergoing Resuscitation and Stabilization

项目摘要 在美国，每年大约有40万名新生儿需要进行复苏。所做的决定 而在生命最初几分钟内进行的干预可以决定孩子是活着、死了还是 在严重的终生疾病中存活。新生儿复苏是一项时间紧迫的活动，需要 团队在特定的步骤序列中协调侵入性程序。因为错误率过高 在新生儿复苏过程中有50%的报道，增强了 这些干预措施将对拯救的生命数量、 幸存者，以及新生儿重症监护的年度费用(目前超过250亿美元)。这部作品 将重点放在改善新生儿复苏的三个具体方面：设计物理 工作空间，在这一侵入性过程中的决策，以及人与技术的互动。 我们将评估目前使用的新生儿复苏环境的范围，并通过模拟 和迭代设计，探索不同的房间配置，以确定便于 增强了团队绩效。我们将研究如何显示关键的解剖和生理数据， 检测负面趋势的数据，并在实际威胁变得明显之前提醒员工。我们会 还可以尝试最大限度地减少处理病人的方法和减少手动操作的需要 调整产生不准确结果并干扰病人护理程序的设备。至 实现这些目标这项提案汇集了临床新生儿、复苏、 工程学、人的因素、以人为中心的设计和医疗模拟。 这个项目在几个方面都很重要。首先，对新生儿采取系统工程的方法 复苏，检查单个子系统(患者、医疗保健专业人员、体检人员 环境、设备、用品、干预、数据、法规、文化)影响整个系统， 我们将开发一个全面的模型，以确定多个潜在的干预点 改善病人护理。其次，因为即使是最简单的分娩也是在低视力的情况下进行的， 低流量的医院或分娩中心可能在几分钟内演变为危及生命的紧急情况 对于新生儿，这项工作的好处将推广到每一个孕妇提供 出生--农村、市中心、城市和郊区。第三，这项研究关注的是新生儿，包括那些出生的 致黑人、拉丁裔、土著和印第安人、亚裔美国人、太平洋岛民和LGBTQ+ 妇女--所有这些人都代表AHRQ的优先人口。最后，这项工作的成果将得到很好的推广 超越新生儿人口，因为它们将适用于改善人和系统的性能 在其他复杂、安全关键、时间紧迫的医疗保健领域，涉及外科、紧急情况 以及儿科、产科和成人患者的重症监护。

Project Summary In the U.S., approximately 400,000 newborns require resuscitation every year. The decisions made and interventions performed in those first minutes of life can determine whether the child lives, dies or survives with significant lifelong morbidity. Neonatal resuscitation is a time-pressured activity requiring teams to coordinate invasive procedures in a specific sequence of steps. Because error rates in excess of 50% during neonatal resuscitation have been reported, enhancing the effectiveness and safety of those interventions will have a profound impact on the number of lives saved, the quality of life for survivors, and the annual cost of neonatal intensive care (which currently surpasses $25B). This work will focus on improving three specific aspects of neonatal resuscitation: the design of the physical workspace, decision making during this invasive procedure, and human-technology interaction. We will assess the range of neonatal resuscitation environments currently in use and, via simulation and iterative design, explore different room configurations to determine the layouts that facilitate enhanced team performance. We will investigate how to display key anatomic and physiologic data, detect data that is trending negatively, and alert staff before an actual threat becomes manifest. We will also experiment with methods of minimizing patient handling and reducing the need for manual adjustments of devices that produce imprecise results and interfere with patient care procedures. To accomplish these aims this proposal brings together experts in clinical neonatology, resuscitation, engineering, human factors, human-centered design and healthcare simulation. This project is significant in several ways. First, by taking a systems engineering approach to neonatal resuscitation, examining how individual subsystems (patients, healthcare professionals, physical environments, equipment, supplies, interventions, data, regulations, culture) impact the overall system, we will develop a comprehensive model that identifies multiple potential points of intervention for improving patient care. Second, because even the most uncomplicated delivery occurring in a low-acuity, low-volume hospital or birth center can evolve within minutes to become a life-threatening emergency for the newborn, the benefits of this work will be generalizable to every facility where pregnant women give birth – rural, inner city, urban and suburban. Third, this study focuses on neonates, including those born to Black, Latino, Indigenous and Native American, Asian American, Pacific Islander and LGBTQ+ women, all of whom represent AHRQ priority populations. Finally, the results of this work will extend well beyond the neonatal population, as they will be applicable to improving human and system performance in other complex, safety-critical, time-pressured healthcare domains involving the surgical, emergency and intensive care of pediatric, obstetric and adult patients.