Skip to main content

Yuval Bitan

Ben Gurion University of the Negev, Industrial Engineering and Management, Faculty Member

Followers

38

Following

12

Co-authors

7

Public Views

Yuval Bitan is a researcher and a Human Factors engineer, specialized in ways to improve patient safety through the implementation of human factors principles in the healthcare complex working environment. Yuval was a Research Associate at the Cognitive Technologies Laboratory (University of Chicago, Illinois), HumanEra (University Health Network, Toronto, Canada) and at the University of Toronto. Yuval holds a Ph.D. in Human Factors Engineering from the Ben-Gurion University of the Negev, Beer-Sheva, Israel, where he teach at the department of Industrial Engineering and Management, and lead the Human Factors in Healthcare laboratory.

less

Vrije Universiteit Brussel

Sayonara Barbosa

University of Cincinnati

Kansas State University

Armando Marques-Guedes

UNL - New University of Lisbon

Macquarie University

Griffith University

Denis A. Coelho

Universidade da Beira Interior

Narahari Nuggenahalli

R. V. College of Engineering

José Francisco Pessanha

UERJ - Universidade do Estado do Rio de Janeiro / Rio de Janeiro State University

Dr Seán McCartan

Coventry University

Interests

Uploads

Papers by Yuval Bitan

The Sukkah Drill: A Novel Approach to Incident Command Training

Clinical simulation in nursing, Jun 1, 2024

Investigating Delays in Updates to Infusion Pump Drug Limit Libraries

PubMed, 2016

Interoperability is a major challenge in current healthcare systems. It brings big hope for data ... more Interoperability is a major challenge in current healthcare systems. It brings big hope for data exchange, but also raises some concern about patient safety. We study the wireless updating of modern infusion pumps and demonstrate the possible flaws in this process. Through analyzing data on drug limit libraries (DLL) versions in one hospital we could identify the delays in distributing DLL updates and the impact these delays might have on patient safety. We found that 31% of all started infusions had used outdated DLL versions, and 22.6% of all alerts were triggered by outdated DLLs. These findings suggest that clinical and operational stakeholders in healthcare systems must address the unreliable interoperability of medical technologies such as seen on infusion pumps. The impact of information inconsistency across healthcare systems might result in use error which would impair patient safety.

Self-initiated and respondent actions in a simulated control task

Ergonomics, May 1, 2007

Operators often need to combine self-initiated and respondent actions. Two experiments dealt with... more Operators often need to combine self-initiated and respondent actions. Two experiments dealt with the relative importance of these two types of actions as a function of the predictability of the system and the available information. Participants monitored three stations with different frequencies at which interventions were required. They were aided by warning cues, indicating the need for interventions. The frequencies of inspections of the stations, the response to the warning system and the overall performance were assessed for warning systems with different diagnostic properties. Participants adapted their responses to the relative frequency of required interventions and the reliance on and compliance to the warning system depended on the warning characteristics. The results support the notion that events, such as warning signals, have a complex role in the ongoing activity of the operator and are integrated into the set of information from external and internal sources that guide the operators&#x27; actions.

Comparing auditory and tactile cues to inform clinicians of patients’ vital signs

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Sep 1, 2020

Ergonomic design of new paramedic response bags

Applied Ergonomics, Nov 1, 2019

A two phase project is described for redesigning and evaluating paramedic response bags, one of t... more A two phase project is described for redesigning and evaluating paramedic response bags, one of the key pieces of equipment used by emergency medical services. Adopting a user-centred approach, Phase I involved first educating active service paramedics about ergonomic principles, and then collaborating with them to conceptualise a new type of response bag, based on separate colour coded kits, each containing related equipment items. Phase II describes a formal evaluation study, involving simulated procedures with a patient mannequin and active service paramedics in a real ambulance. Results indicated subjective preferences for the new bags, where 62% of the paramedics believed it was easier to find equipment in the new bag and 65% preferred the new bags overall. No detrimental effects were attributed to the transition to the new bag. Also discussed are the advantages of the participatory design approach, as well as design guidelines and implications for paramedic operations.

Evaluation of tactile cues for simulated patients’ status under high and low workload

Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting, Nov 1, 2019

The intensive care unit (ICU) is one of the most complex areas in hospital care, as patients requ... more The intensive care unit (ICU) is one of the most complex areas in hospital care, as patients require continuous monitoring by physicians and nurses. Currently, clinicians are informed about the patients' physiological conditions through visual color-coded signals and auditory alarms. Previous studies have shown that vibrotactile cues can be used to inform clinicians of a patient's vital signs status, either in a unisensory or multisensory alarm scheme. We present the results of the first in a series of experiments devoted to examining the feasibility to use tactile cues to convey detailed physiological information about more than one patient, rendered through a lower-leg tactile interface. The current experiment utilized a simulated clinical environment with 14 undergraduate students. Participants were required to interpret information delivered by the tactile interface, for two different patients, while they performed a continuous cognitively demanding task. Results indicate that under such conditions, it is possible to deliver critical information with a successful interpretation rate of approximately 85% but not without cost to the continuous demanding task. Future experiments should evaluate more tactile patterns in order to increase their interpretation success rate, and evaluate the use of these tactile cues with clinicians.

Prevalence of wireless smart-pump drug library update delays

American Journal of Health-system Pharmacy, Aug 1, 2018

Displaying a boundary in graphic and symbolic “wait” displays: Duration estimates and users’ preferences

International Journal of Human-computer Interaction, Jul 1, 1995

Two experiments assessed the effect of displaying a boundary on duration estimates and preference... more Two experiments assessed the effect of displaying a boundary on duration estimates and preference ratings for dynamic displays that were shown while users waited for the system&amp;amp;amp;amp;#x27;s response. Displays were either symbolic (changing numbers) or graphic (increasing rectangles) and could contain a boundary that indicated when the interval was expected to be over. Duration estimates were similar for symbolic and graphic displays and for displays with and without a boundary. However, when the displays were encountered successively ...

Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays

Journal of Patient Safety, Mar 1, 2019

Objective: Our previous study showed that the issue of drug library update delays on wireless int... more Objective: Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts. Methods: The study data sets included infusion logs and drug libraries from three hospitals of one health system from January 2015 to December 2016. We identified limit setting changes of any two consecutive drug library versions. We quantified the impact of using outdated drug limit settings by missed and false infusion programming alerts. Results: Twenty-five updates of the drug library were released within the health system during the 2-year period with an average interval of 28.8 days. After a new library version was issued, it took at least 6 days for 50% of all pumps to become up-to-date and 15 days or more to reach 80%. All three hospitals had at least 16% of all IV infusions programmed with outdated libraries. This resulted in 18%, 24.4%, and 27% of false alerts in the three hospitals, respectively. We identified two cases of missed alert infusions of high-risk medications, propofol, and potassium chloride, which could have negatively impacted patient safety. Conclusions: These findings support our assumption that potential serious harm can happen when IV infusions are administered with outdated drug limit settings due to delays in drug library updates on the pump.

Increasing Intensivists’ Trust in a machine learning-Based Bacteremia Diagnosis System Through User-Interface Design: The Impact of Information Relevancy and Interactivity (Preprint)

BACKGROUND The exponential growth in computing power and increasing digitization of information h... more BACKGROUND The exponential growth in computing power and increasing digitization of information have advanced the machine learning (ML) research field substantially. However, ML algorithms are often considered “black boxes”, and this fosters distrust. In medical domains, in which mistakes can result in fatal outcomes, practitioners may be especially reluctant to trust ML algorithms. OBJECTIVE To explore the effect of user-interface design features on intensivists’ trust in a ML-based clinical decision support system. METHODS Forty-seven physicians from critical care specialties were presented three patient cases of bacteremia in the setting of an ML-based simulation system. Three conditions of the simulation were tested according to combinations of information relevancy and interactivity. Participants’ trust in the system was assessed by their agreement with the system’s diagnoses and a post-experiment questionnaire. Linear regression models were applied to measure the effects RESULTS Participants’ agreement with the system’s diagnoses did not differ according to the experimental conditions. However, in the post-experiment questionnaire, higher information relevancy ratings and interactivity ratings were associated with higher perceived trust in the system (P &amp;amp;lt; 0.001 for both). The explicit visual presentation of the features of the ML algorithm on the user-interface resulted in lower trust by the participants (P &amp;amp;lt; 0.05). CONCLUSIONS : Information relevancy and interactivity features should be considered in the design of user interface of ML-based clinical decision support systems, to enhance intensivists’ trust. This study sheds light on the connection between information relevancy, interactivity, and trust in human–ML interaction, specifically in the intensive care unit environment. CLINICALTRIAL Non- clinical

Scheduling of Actions and Reliance on Warnings in a Simulated Control Task

Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting, Sep 1, 1999

Operators of complex systems respond to external signals and events that guide their actions, but... more Operators of complex systems respond to external signals and events that guide their actions, but they also initiate and schedule the performance of various acts. An experiment was conducted in which the interdependence of scheduling and responding was studied. Participants had to monitor three stations that required different rates of interventions. The experimental conditions differed in the parameters of a warning system that indicated a possible malfunction in a station. The results showed that participants adjusted the frequencies of inspection in accordance with the required frequencies, but the adjustment was much smaller than was actually required. The settings of the warning's sensitivity and criterion threshold affected different aspects of the reliance on the warning system, and a distinction between reliance on warnings and obedience to warnings is suggested. The implications of these findings for the modeling of user actions in complex systems are discussed.

Shape Matters: A Neglected Feature of Medication Safety

Journal of Medical Systems, Dec 31, 2022

The impact of data quality defects on clinical decision-making in the intensive care unit

Computer Methods and Programs in Biomedicine, Sep 1, 2021

OBJECTIVE Poor clinical data quality might affect clinical decision making and patient treatment.... more OBJECTIVE Poor clinical data quality might affect clinical decision making and patient treatment. This study identifies quality defects in clinical data collected automatically by bedside monitoring devices in the Intensive Care Unit (ICU) and examines their effect on clinical decisions. METHODS Real-world data collected from 7688 patients admitted to the general ICU in a tertiary referral hospital over seven years was retrospectively analyzed. Data quality defect detection methods that use time-series analysis techniques identified two types of data quality defects: (a) completeness: the extent of non-missing values, and (b) validity: the extent of non-extreme values within the continuous range of values. Data quality defects were compared to five scenarios of medication and procedure prescriptions that are common in ICU settings: Blood-pressure reduction, blood-pressure elevation, anesthesia medications, intubation procedures, and muscle relaxant medications. RESULTS Results from a logistic regression revealed a strong connection between data quality and the clinical interventions examined: lower validity level increased the likelihood of prescription decisions for all five scenarios, and lower completeness level increased the likelihood of prescription decisions for some scenarios. DISCUSSION The results highlight the possible effect of data quality defects on physicians' decisions. Lower validity of certain key clinical parameters, and in some scenarios lower completeness, correlated with stronger tendency to prescribe medications or perform invasive procedures. CONCLUSIONS Data quality defects in clinical data affect decision making even without practitioners' awareness. Thus, it is important to emphasize these effects to ICU staff, as well as to medical device manufacturers.

Correlating data from different sensors to increase the positive predictive value of alarms: an empiric assessment

F1000Research, Nov 8, 2012

Alarm fatigue from high false alarm rate is a well described Objectives: phenomenon in the intens... more Alarm fatigue from high false alarm rate is a well described Objectives: phenomenon in the intensive care unit (ICU). Progress to further reduce false alarms must employ a new strategy. Highly sensitive alarms invariably have a very high false alarm rate. Clinically useful alarms have a high Positive-Predictive Value. Our goal is to demonstrate one approach to suppressing false alarms using an algorithm that correlates information across sensors and replicates the ways that human evaluators discriminate artifact from real signal. After obtaining IRB approval and waiver of informed consent, a Methods: set of definitions, (hypovolemia, left ventricular shock, tamponade, hemodynamically significant ventricular tachycardia, and hemodynamically significant supraventricular tachycardia), were installed in the monitors in a 10 bed cardiothoracic ICU and evaluated over an 85 day study period. The logic of the algorithms was intended to replicate the logic of practitioners, and correlated information across sensors in a way similar to that used by practitioners. The performance of the alarms was evaluated via a daily interview with the ICU attending and review of the tracings recorded over the previous 24 hours in the monitor. True alarms and false alarms were identified by an expert clinician, and the performance of the algorithms evaluated using the standard definitions of sensitivity, specificity, positive predictive value, and negative predictive value. Between 1 and 221 instances of defined events occurred over the Results: duration of the study, and the positive predictive value of the definitions varied between 4.1% and 84%. Correlation of information across alarms can suppress Conclusions: artifact, increase the positive predictive value of alarms, and can employ more sophisticated definitions of alarm events than present single-sensor based systems.

Improving Healthcare Practice Through the Implementation of Human Factors and Ergonomics Principles

Human Factors, Aug 10, 2022

Objective Present a collection of papers focusing on improving healthcare practice through the im... more Objective Present a collection of papers focusing on improving healthcare practice through the implementation of human factors and ergonomics principles that were presented at the International Ergonomics Association (IEA) 2021 international conference. Background The mission of the IEA is to elaborate and advance ergonomics science and practice and to expand its scope of application. Method We reviewed papers that were submitted for presentation at the IEA 2021 international conference and focused on improving healthcare practice through the implementation of human factors and ergonomics principles. Results The eight papers that are included in this special issue cover varied aspects of human factors application and implementation. Conclusion This special issue provides clear evidence that the science of human factors is relevant and is continuing to grow and so is its implementation in healthcare. Application This special issue offers a selection of applied works, providing a wide scope of human factors guidelines, methods, and theories in healthcare work environments.

Improving Identification and Distinguishability of Medication Labels

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Sep 1, 2020

Background and Aims: The objective of the present study was development and validation of a simpl... more Background and Aims: The objective of the present study was development and validation of a simple and rapid method for determination of heparin in pharmaceutical products. Methods: The separation was achieved by 50 µm i.d. 50 cm bare fused silica capillary with phosphate buffer 72 mM (pH = 3.5) at 35 °C. The applied voltage was set at-30 KV. Heparin was detected at 200 nm. The proposed method was validated in terms of linearity, accuracy, precision, limit of quantification (LOQ) and limit of detection (LOD). Results: The results indicated that the method was linear in the range of 0.3 to 15 mg/ml, accurate (between 97.26% and 99.77%) and precise (RSD between 0.27% and 2.35%) with LOD of 78 microg/ml and LOQ of 312 microg/ml. The migration time of heparin was 2.39 ± 0.13 minutes. Heparin content in the pharmaceutical products was determined and the average assayed amount was 97.3 ± 2.3 % (n = 3), which is only 0.76 mg/ml deviated from the label claim. Conclusions: In the present work, a rapid and simple capillary zone electrophoresis method, developed and validated in terms of linearity, precision and accuracy, for determination of heparin. The proposed method successfully used for quantification of heparin sodium in pharmaceutical samples and could be applied for quality control of heparin products in quality control laboratories.

Optimizing the Design of Visual Patterns for Labels

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Jun 1, 2018

Administering medications is a common and often critical component of prehospital treatment by pa... more Administering medications is a common and often critical component of prehospital treatment by paramedics. Unfortunately, studies have shown that medication errors also occur regularly. In a survey conducted by Vilke et al. (2007), 9.1% of responding paramedics voluntarily reported committing a medication error within the previous 12 months. A review of hospital treatment records by Lifshitz el al. (2012) reported that 13% of cases involving prehospital care medications resulted in errors. Whereas administering wrong medications constituted only 4% of the errors reported by Vilke et al., the consequences of such errors can be life threatening. Despite protocols intended to ensure correctness by reading labels prior to use, lapses can occur and be complicated by other potential sources of error. For example, it is not uncommon for the visual appearance of medications to change as suppliers change from one procurement cycle to the next. Additionally, medications are often stored in such a way that their labelling is obscured, thus hampering visual identification.

Evaluation of Ergonomically Redesigned Paramedic Bags – A Usability Study

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Jun 1, 2016

Motivated by the premise that well designed paramedic response bags can improve paramedics’ perfo... more Motivated by the premise that well designed paramedic response bags can improve paramedics’ performance and patient safety, our objectives in this study were to evaluate performance and preferences when comparing traditional response bags with new ergonomically designed bags. A usability study based on two emergency scenarios was carried out, using 17 active duty paramedic teams as participants. Although most of the objective performance results were not statistically significant, the subjective results showed a clear preference for the new bags.

Determining the Weights of Scheduling and Responding in the Control of a dynamic System

Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting, Oct 1, 2003

Operators of complex systems combine actions they schedule and initiate, and actions they perform... more Operators of complex systems combine actions they schedule and initiate, and actions they perform as responses to events (such as alarms). Previous studies showed qualitative changes in the effect of scheduling and responding, but no quantitative measures of the relative weight of scheduled and respondent actions were available. The paper suggests the use of standardized weights from logstic regression analyses as a possible measure. The measure was computed for responses of individual users in a study in which participants had to monitor three stations that required different rates of interventions. The experimental conditions differed in the reliability of a warning system that indicated a possible malfunction in a station and in the system's predictability. Logistic regressions were run to predict operator actions as a function of the time since the last action and of the information from the warning system. The weights were found to be sensitive to the diagnostic value of the warning indicator and the predictability of the system.

Effect of the User Input Method on Response Time and Accuracy in a Binary Data Labeling Task

International Journal of Human-computer Interaction, Oct 4, 2022

The Sukkah Drill: A Novel Approach to Incident Command Training

Clinical simulation in nursing, Jun 1, 2024

Investigating Delays in Updates to Infusion Pump Drug Limit Libraries

PubMed, 2016

Interoperability is a major challenge in current healthcare systems. It brings big hope for data ... more Interoperability is a major challenge in current healthcare systems. It brings big hope for data exchange, but also raises some concern about patient safety. We study the wireless updating of modern infusion pumps and demonstrate the possible flaws in this process. Through analyzing data on drug limit libraries (DLL) versions in one hospital we could identify the delays in distributing DLL updates and the impact these delays might have on patient safety. We found that 31% of all started infusions had used outdated DLL versions, and 22.6% of all alerts were triggered by outdated DLLs. These findings suggest that clinical and operational stakeholders in healthcare systems must address the unreliable interoperability of medical technologies such as seen on infusion pumps. The impact of information inconsistency across healthcare systems might result in use error which would impair patient safety.

Self-initiated and respondent actions in a simulated control task

Ergonomics, May 1, 2007

Operators often need to combine self-initiated and respondent actions. Two experiments dealt with... more Operators often need to combine self-initiated and respondent actions. Two experiments dealt with the relative importance of these two types of actions as a function of the predictability of the system and the available information. Participants monitored three stations with different frequencies at which interventions were required. They were aided by warning cues, indicating the need for interventions. The frequencies of inspections of the stations, the response to the warning system and the overall performance were assessed for warning systems with different diagnostic properties. Participants adapted their responses to the relative frequency of required interventions and the reliance on and compliance to the warning system depended on the warning characteristics. The results support the notion that events, such as warning signals, have a complex role in the ongoing activity of the operator and are integrated into the set of information from external and internal sources that guide the operators&#x27; actions.

Comparing auditory and tactile cues to inform clinicians of patients’ vital signs

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Sep 1, 2020

Ergonomic design of new paramedic response bags

Applied Ergonomics, Nov 1, 2019

A two phase project is described for redesigning and evaluating paramedic response bags, one of t... more A two phase project is described for redesigning and evaluating paramedic response bags, one of the key pieces of equipment used by emergency medical services. Adopting a user-centred approach, Phase I involved first educating active service paramedics about ergonomic principles, and then collaborating with them to conceptualise a new type of response bag, based on separate colour coded kits, each containing related equipment items. Phase II describes a formal evaluation study, involving simulated procedures with a patient mannequin and active service paramedics in a real ambulance. Results indicated subjective preferences for the new bags, where 62% of the paramedics believed it was easier to find equipment in the new bag and 65% preferred the new bags overall. No detrimental effects were attributed to the transition to the new bag. Also discussed are the advantages of the participatory design approach, as well as design guidelines and implications for paramedic operations.

Evaluation of tactile cues for simulated patients’ status under high and low workload

Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting, Nov 1, 2019

The intensive care unit (ICU) is one of the most complex areas in hospital care, as patients requ... more The intensive care unit (ICU) is one of the most complex areas in hospital care, as patients require continuous monitoring by physicians and nurses. Currently, clinicians are informed about the patients' physiological conditions through visual color-coded signals and auditory alarms. Previous studies have shown that vibrotactile cues can be used to inform clinicians of a patient's vital signs status, either in a unisensory or multisensory alarm scheme. We present the results of the first in a series of experiments devoted to examining the feasibility to use tactile cues to convey detailed physiological information about more than one patient, rendered through a lower-leg tactile interface. The current experiment utilized a simulated clinical environment with 14 undergraduate students. Participants were required to interpret information delivered by the tactile interface, for two different patients, while they performed a continuous cognitively demanding task. Results indicate that under such conditions, it is possible to deliver critical information with a successful interpretation rate of approximately 85% but not without cost to the continuous demanding task. Future experiments should evaluate more tactile patterns in order to increase their interpretation success rate, and evaluate the use of these tactile cues with clinicians.

Prevalence of wireless smart-pump drug library update delays

American Journal of Health-system Pharmacy, Aug 1, 2018

Displaying a boundary in graphic and symbolic “wait” displays: Duration estimates and users’ preferences

International Journal of Human-computer Interaction, Jul 1, 1995

Two experiments assessed the effect of displaying a boundary on duration estimates and preference... more Two experiments assessed the effect of displaying a boundary on duration estimates and preference ratings for dynamic displays that were shown while users waited for the system&amp;amp;amp;amp;#x27;s response. Displays were either symbolic (changing numbers) or graphic (increasing rectangles) and could contain a boundary that indicated when the interval was expected to be over. Duration estimates were similar for symbolic and graphic displays and for displays with and without a boundary. However, when the displays were encountered successively ...

Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays

Journal of Patient Safety, Mar 1, 2019

Objective: Our previous study showed that the issue of drug library update delays on wireless int... more Objective: Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts. Methods: The study data sets included infusion logs and drug libraries from three hospitals of one health system from January 2015 to December 2016. We identified limit setting changes of any two consecutive drug library versions. We quantified the impact of using outdated drug limit settings by missed and false infusion programming alerts. Results: Twenty-five updates of the drug library were released within the health system during the 2-year period with an average interval of 28.8 days. After a new library version was issued, it took at least 6 days for 50% of all pumps to become up-to-date and 15 days or more to reach 80%. All three hospitals had at least 16% of all IV infusions programmed with outdated libraries. This resulted in 18%, 24.4%, and 27% of false alerts in the three hospitals, respectively. We identified two cases of missed alert infusions of high-risk medications, propofol, and potassium chloride, which could have negatively impacted patient safety. Conclusions: These findings support our assumption that potential serious harm can happen when IV infusions are administered with outdated drug limit settings due to delays in drug library updates on the pump.

Increasing Intensivists’ Trust in a machine learning-Based Bacteremia Diagnosis System Through User-Interface Design: The Impact of Information Relevancy and Interactivity (Preprint)

BACKGROUND The exponential growth in computing power and increasing digitization of information h... more BACKGROUND The exponential growth in computing power and increasing digitization of information have advanced the machine learning (ML) research field substantially. However, ML algorithms are often considered “black boxes”, and this fosters distrust. In medical domains, in which mistakes can result in fatal outcomes, practitioners may be especially reluctant to trust ML algorithms. OBJECTIVE To explore the effect of user-interface design features on intensivists’ trust in a ML-based clinical decision support system. METHODS Forty-seven physicians from critical care specialties were presented three patient cases of bacteremia in the setting of an ML-based simulation system. Three conditions of the simulation were tested according to combinations of information relevancy and interactivity. Participants’ trust in the system was assessed by their agreement with the system’s diagnoses and a post-experiment questionnaire. Linear regression models were applied to measure the effects RESULTS Participants’ agreement with the system’s diagnoses did not differ according to the experimental conditions. However, in the post-experiment questionnaire, higher information relevancy ratings and interactivity ratings were associated with higher perceived trust in the system (P &amp;amp;lt; 0.001 for both). The explicit visual presentation of the features of the ML algorithm on the user-interface resulted in lower trust by the participants (P &amp;amp;lt; 0.05). CONCLUSIONS : Information relevancy and interactivity features should be considered in the design of user interface of ML-based clinical decision support systems, to enhance intensivists’ trust. This study sheds light on the connection between information relevancy, interactivity, and trust in human–ML interaction, specifically in the intensive care unit environment. CLINICALTRIAL Non- clinical

Scheduling of Actions and Reliance on Warnings in a Simulated Control Task

Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting, Sep 1, 1999

Operators of complex systems respond to external signals and events that guide their actions, but... more Operators of complex systems respond to external signals and events that guide their actions, but they also initiate and schedule the performance of various acts. An experiment was conducted in which the interdependence of scheduling and responding was studied. Participants had to monitor three stations that required different rates of interventions. The experimental conditions differed in the parameters of a warning system that indicated a possible malfunction in a station. The results showed that participants adjusted the frequencies of inspection in accordance with the required frequencies, but the adjustment was much smaller than was actually required. The settings of the warning's sensitivity and criterion threshold affected different aspects of the reliance on the warning system, and a distinction between reliance on warnings and obedience to warnings is suggested. The implications of these findings for the modeling of user actions in complex systems are discussed.

Shape Matters: A Neglected Feature of Medication Safety

Journal of Medical Systems, Dec 31, 2022

The impact of data quality defects on clinical decision-making in the intensive care unit

Computer Methods and Programs in Biomedicine, Sep 1, 2021

OBJECTIVE Poor clinical data quality might affect clinical decision making and patient treatment.... more OBJECTIVE Poor clinical data quality might affect clinical decision making and patient treatment. This study identifies quality defects in clinical data collected automatically by bedside monitoring devices in the Intensive Care Unit (ICU) and examines their effect on clinical decisions. METHODS Real-world data collected from 7688 patients admitted to the general ICU in a tertiary referral hospital over seven years was retrospectively analyzed. Data quality defect detection methods that use time-series analysis techniques identified two types of data quality defects: (a) completeness: the extent of non-missing values, and (b) validity: the extent of non-extreme values within the continuous range of values. Data quality defects were compared to five scenarios of medication and procedure prescriptions that are common in ICU settings: Blood-pressure reduction, blood-pressure elevation, anesthesia medications, intubation procedures, and muscle relaxant medications. RESULTS Results from a logistic regression revealed a strong connection between data quality and the clinical interventions examined: lower validity level increased the likelihood of prescription decisions for all five scenarios, and lower completeness level increased the likelihood of prescription decisions for some scenarios. DISCUSSION The results highlight the possible effect of data quality defects on physicians' decisions. Lower validity of certain key clinical parameters, and in some scenarios lower completeness, correlated with stronger tendency to prescribe medications or perform invasive procedures. CONCLUSIONS Data quality defects in clinical data affect decision making even without practitioners' awareness. Thus, it is important to emphasize these effects to ICU staff, as well as to medical device manufacturers.

Correlating data from different sensors to increase the positive predictive value of alarms: an empiric assessment

F1000Research, Nov 8, 2012

Alarm fatigue from high false alarm rate is a well described Objectives: phenomenon in the intens... more Alarm fatigue from high false alarm rate is a well described Objectives: phenomenon in the intensive care unit (ICU). Progress to further reduce false alarms must employ a new strategy. Highly sensitive alarms invariably have a very high false alarm rate. Clinically useful alarms have a high Positive-Predictive Value. Our goal is to demonstrate one approach to suppressing false alarms using an algorithm that correlates information across sensors and replicates the ways that human evaluators discriminate artifact from real signal. After obtaining IRB approval and waiver of informed consent, a Methods: set of definitions, (hypovolemia, left ventricular shock, tamponade, hemodynamically significant ventricular tachycardia, and hemodynamically significant supraventricular tachycardia), were installed in the monitors in a 10 bed cardiothoracic ICU and evaluated over an 85 day study period. The logic of the algorithms was intended to replicate the logic of practitioners, and correlated information across sensors in a way similar to that used by practitioners. The performance of the alarms was evaluated via a daily interview with the ICU attending and review of the tracings recorded over the previous 24 hours in the monitor. True alarms and false alarms were identified by an expert clinician, and the performance of the algorithms evaluated using the standard definitions of sensitivity, specificity, positive predictive value, and negative predictive value. Between 1 and 221 instances of defined events occurred over the Results: duration of the study, and the positive predictive value of the definitions varied between 4.1% and 84%. Correlation of information across alarms can suppress Conclusions: artifact, increase the positive predictive value of alarms, and can employ more sophisticated definitions of alarm events than present single-sensor based systems.

Improving Healthcare Practice Through the Implementation of Human Factors and Ergonomics Principles

Human Factors, Aug 10, 2022

Objective Present a collection of papers focusing on improving healthcare practice through the im... more Objective Present a collection of papers focusing on improving healthcare practice through the implementation of human factors and ergonomics principles that were presented at the International Ergonomics Association (IEA) 2021 international conference. Background The mission of the IEA is to elaborate and advance ergonomics science and practice and to expand its scope of application. Method We reviewed papers that were submitted for presentation at the IEA 2021 international conference and focused on improving healthcare practice through the implementation of human factors and ergonomics principles. Results The eight papers that are included in this special issue cover varied aspects of human factors application and implementation. Conclusion This special issue provides clear evidence that the science of human factors is relevant and is continuing to grow and so is its implementation in healthcare. Application This special issue offers a selection of applied works, providing a wide scope of human factors guidelines, methods, and theories in healthcare work environments.

Improving Identification and Distinguishability of Medication Labels

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Sep 1, 2020

Background and Aims: The objective of the present study was development and validation of a simpl... more Background and Aims: The objective of the present study was development and validation of a simple and rapid method for determination of heparin in pharmaceutical products. Methods: The separation was achieved by 50 µm i.d. 50 cm bare fused silica capillary with phosphate buffer 72 mM (pH = 3.5) at 35 °C. The applied voltage was set at-30 KV. Heparin was detected at 200 nm. The proposed method was validated in terms of linearity, accuracy, precision, limit of quantification (LOQ) and limit of detection (LOD). Results: The results indicated that the method was linear in the range of 0.3 to 15 mg/ml, accurate (between 97.26% and 99.77%) and precise (RSD between 0.27% and 2.35%) with LOD of 78 microg/ml and LOQ of 312 microg/ml. The migration time of heparin was 2.39 ± 0.13 minutes. Heparin content in the pharmaceutical products was determined and the average assayed amount was 97.3 ± 2.3 % (n = 3), which is only 0.76 mg/ml deviated from the label claim. Conclusions: In the present work, a rapid and simple capillary zone electrophoresis method, developed and validated in terms of linearity, precision and accuracy, for determination of heparin. The proposed method successfully used for quantification of heparin sodium in pharmaceutical samples and could be applied for quality control of heparin products in quality control laboratories.

Optimizing the Design of Visual Patterns for Labels

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Jun 1, 2018

Administering medications is a common and often critical component of prehospital treatment by pa... more Administering medications is a common and often critical component of prehospital treatment by paramedics. Unfortunately, studies have shown that medication errors also occur regularly. In a survey conducted by Vilke et al. (2007), 9.1% of responding paramedics voluntarily reported committing a medication error within the previous 12 months. A review of hospital treatment records by Lifshitz el al. (2012) reported that 13% of cases involving prehospital care medications resulted in errors. Whereas administering wrong medications constituted only 4% of the errors reported by Vilke et al., the consequences of such errors can be life threatening. Despite protocols intended to ensure correctness by reading labels prior to use, lapses can occur and be complicated by other potential sources of error. For example, it is not uncommon for the visual appearance of medications to change as suppliers change from one procurement cycle to the next. Additionally, medications are often stored in such a way that their labelling is obscured, thus hampering visual identification.

Evaluation of Ergonomically Redesigned Paramedic Bags – A Usability Study

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, Jun 1, 2016

Motivated by the premise that well designed paramedic response bags can improve paramedics’ perfo... more Motivated by the premise that well designed paramedic response bags can improve paramedics’ performance and patient safety, our objectives in this study were to evaluate performance and preferences when comparing traditional response bags with new ergonomically designed bags. A usability study based on two emergency scenarios was carried out, using 17 active duty paramedic teams as participants. Although most of the objective performance results were not statistically significant, the subjective results showed a clear preference for the new bags.

Determining the Weights of Scheduling and Responding in the Control of a dynamic System

Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting, Oct 1, 2003

Operators of complex systems combine actions they schedule and initiate, and actions they perform... more Operators of complex systems combine actions they schedule and initiate, and actions they perform as responses to events (such as alarms). Previous studies showed qualitative changes in the effect of scheduling and responding, but no quantitative measures of the relative weight of scheduled and respondent actions were available. The paper suggests the use of standardized weights from logstic regression analyses as a possible measure. The measure was computed for responses of individual users in a study in which participants had to monitor three stations that required different rates of interventions. The experimental conditions differed in the reliability of a warning system that indicated a possible malfunction in a station and in the system's predictability. Logistic regressions were run to predict operator actions as a function of the time since the last action and of the information from the warning system. The weights were found to be sensitive to the diagnostic value of the warning indicator and the predictability of the system.

Effect of the User Input Method on Response Time and Accuracy in a Binary Data Labeling Task

International Journal of Human-computer Interaction, Oct 4, 2022