There is a growing trend to conduct simulation-based mock-up evaluations as part of the process to design healthcare facilities. Health Quality Alberta (HQA) has published a framework to provide guidance for organizations wanting to integrate this evaluation methodology into their healthcare facility design process. Several national and international hospital design standards recommend using the framework. Simulation-based mock-up evaluations of various rooms (client rooms, washrooms, medication rooms, and dialysis stations) planned for a new complex continuing care facility were conducted. Healthcare delivery organizations CapitalCare, Alberta Health Services, and HQA conducted the evaluations collaboratively. The evaluations were intended to inform design modifications to enhance client and staff safety for the unique cohorts to be served at this continuing care centre. Observational assessments and staff/client engagement informed evidence-based recommendations that were incorporated into the planned design of the facility.

This paper presents the work of the sixth Consensus Committee on Recommended Standards for Newborn intensive care unit (NICU) design. Recommended standards for NICU structure, lighting, noise control, infection control, family support and other design considerations are offered, along with supporting interpretations, references and a glossary of terms.

This paper reports on the Patient Safety Research and Application Competition that was held in conjunction with the 2021 International Ergonomics Association Conference. The objectives of this competition were to: (1) Formulate research problem statements and innovative solutions to improve patient safety through the application of human factors/ergonomics (HF/E) to the healthcare system, (2) Showcase how the HF/E approach to this topic can lead to a useful, usable, and satisfying user experience while simultaneously improving outcomes relating to both functional and non-functional requirements, and (3) Provide an effective way of engaging students and early career researchers in IEA activities and initiatives. After reviewing the patient safety topics that motivated the design competition, we then report on the work carried out by the two finalists in the competition, and discuss lessons learned. We propose the continued use of design competitions in the future to motivate and showcase ergonomic problem-solving design by students and early career researchers and practitioners.

This paper reports on the Patient Safety Research and Application Competition that was held in conjunction with the 2021 International Ergonomics Association Conference. The objectives of this competition were to: (1) Formulate research problem statements and innovative solutions to improve patient safety through the application of human factors/ergonomics (HF/E) to the healthcare system, (2) Showcase how the HF/E approach to this topic can lead to a useful, usable, and satisfying user experience while simultaneously improving outcomes relating to both functional and nonfunctional requirements, and (3) Provide an effective way of engaging students and early career researchers in IEA activities and initiatives. After reviewing the patient safety topics that motivated the design competition, we then report on the work carried out by the two finalists in the competition, and discuss lessons learned. We propose the continued use of design competitions in the future to motivate and showcase ergonomic problem-solving design by students and early career researchers and practitioners.

(1) Background: There are many complexities and trade-offs that design teams consider when designing or renovating a built environment for healthcare. Virtual reality (VR) mock-ups can allow design teams to evaluate the planned design. This study aimed to examine the overall value of using VR mock-ups to conduct a simulation-based mock-up evaluation. (2) Methods: Data collected from scenario enactments within a VR mock-up was compared to data collected from an existing medication room with the same design to assess predictive validity. Outcomes regarding quality and patient safety were also examined as a result of design modifications to the VR mock-up which were identified through a post-occupancy evaluation (POE) of the existing medication room. Survey data from participants, hospital design stakeholders, and POE recommendation recipients captured perceptions regarding the evaluation process. Specifically, this included perceptions regarding mock-up and scenario realism as well as utility of the evaluation process. (3) Results: Evidence-based data collected using the VR mock-up accurately assessed workflow (link analysis), bumps, impediments, interruptions, and task completion times. Collecting data pertaining to selection errors and equipment placement were identified after procuring the VR software and therefore the accuracy of these measures was not assessed. Searching behaviours were not possible to capture using the VR software. A 506% return on investment was achieved through the VR mock-up evaluations. (4) Conclusion: Organizations should consider what evaluation objectives are planned and how they will be measured for a mock-up evaluation to determine if VR is appropriate.

PURPOSE:The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning.BACKGROUND:Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada.METHODS:A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations.RESULTS:The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

Designing or renovating a physical environment for healthcare is a complex process and is critical for both the staff and the patients who rely on the environment to support and facilitate patient care. Conducting a simulation-based mock-up evaluation as part of the design process can enhance patient safety, staff efficiency, as well as user experience, and can yield financial returns. A large urban tertiary care center located in Vancouver, Canada followed a framework to evaluate the proposed design template for 28 universal operating rooms (ORs) included within the OR Renewal Project scope. Simulation scenarios were enacted by nursing staff, surgeons, anesthesiologists, residents, radiology techs, and anesthesia assistants. Video and debriefing data were used to conduct link analyses, as well as analyses of observed behaviors including congestions and bumps to generate recommendations for evidence-based design changes that were presented to the project team. Recommendations incorporated into the design included relocating doors, booms, equipment, and supplies, as well as reconfigurations to workstations. These recommendations were also incorporated into the mock-up and retested to iteratively develop and evaluate the design. Findings suggest that incorporating the recommended design changes resulted in better room utilization, decreased congestion, and enhanced access to equipment.

Purpose: The aim of this article is to outline overall goals, recommendations, and provide practical How-To strategies for developing and facilitating patient safety and system integration (PSSI) simulations for healthcare team members and organizations. Background: Simulation is increasingly being used as a quality improvement tool to better understand the tasks, environments, and processes that support the delivery of healthcare services. These PSSI simulations paired with system-focused debriefing can occur prior to implementing a new process or workflow to proactively identify system issues. They occur as part of a continuous cycle of quality improvement and have unique considerations for planning, implementation, and delivery of healthcare. Method: The Delphi technique was used to develop the recommendations and How-To strategies to guide those interested in conducting a PSSI simulations. The Delphi technique is a structured communication technique and systematic process of gathering information from a group of identified experts through a series of questionnaires to gain consensus regarding judgments on complex processes, where precise information is not available in the literature. The Delphi technique permitted an iterative and multistaged approach to transform expert opinions into group consensus. Results: The goals, recommendations, and How-To strategies include a focus on project management, stakeholder engagement, sponsorship, scenario design, prebriefing and debriefing, and evaluation metrics. The intent is to proactively identify system issues and disseminate actionable findings. Conclusions: This article highlights salient features to consider when using simulation as a strategy and tool for patient safety and quality improvement.

This paper describes the process and tools developed as part of a multidisciplinary collaborative simulation-based approach for iterative design and evaluation of operating room (OR) prototypes. Full-scale physical mock-ups of healthcare spaces offer an opportunity to actively communicate with and to engage multidisciplinary stakeholders in the design process. While mock-ups are increasingly being used in healthcare facility design projects, they are rarely evaluated in a manner to support active user feedback and engagement. Researchers and architecture students worked closely with clinicians and architects to develop OR design prototypes and engaged clinical end-users in simulated scenarios. An evaluation toolkit was developed to compare design prototypes. The mock-up evaluation helped the team make key decisions about room size, location of OR table, intra-room zoning, and doors location. Structured simulation based mock-up evaluations conducted in the design process can help stakeholders visualize their future workspace and provide active feedback.

Following a review of a chemotherapy medication adverse event where the incorrect medication was prepared by a pharmacy, a number of steps were taken to review the literature and best practice information related to checking processes for the preparation of parenteral chemotherapy. Concepts such as identification of critical stop check points, independent double checks, and human factors principles were reviewed and incorporated into newly designed chemotherapy preparation worksheets with embedded checklists. Usability testing and staff feedback during implementation revealed a number of key learning points that resulted in additional work to further improve the chemotherapy worksheets with embedded checklists and highlighted the need for a culture of continuous quality improvement.

Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting existing ones, to address the need for single-site flexible haemorrhage control. This manuscript therefore describes the many considerations in the design and refinement of the physical build, equipment selection, human factors evaluation of new combined treatment paradigms, and the final introduction of a RAPTOR protocol in order that others may learn from our initial efforts.

A state-of-the-art Interventional Trauma Operating Room (ITOR) combining the techniques of traditional surgery and interventional radiological procedures was designed to address major hemorrhage in the operating room. A Human Factors evaluation using video capture and patient simulation was conducted within a full scale mock-up environment to examine staff workflow and team integration to maximize the multi-user potential of the physical space and identify issues or barriers that would impact patient care during procedures. Recommended changes based on the evaluation included increasing the available space in the ITOR, re-organizing equipment to maximize workflow and relocating patient monitors for maximal visibility.

BACKGROUND:Pharmaceutical companies use a variety of abbreviations to denote short- and long-acting medications. Errors involving the administration of these medications are frequently reported.OBJECTIVES:To evaluate comprehension rates for abbreviations used to denote short- and long-acting medications and to evaluate whether changes to medication labels could reduce potential errors in the selection and administration of medications.METHODS:In phase 1 of the study, nursing staff were asked to define 4 abbreviations and then to categorize them by release rate. In phase 2, a simulation exercise, nursing staff were asked if it would be appropriate to administer a medication illustrated in a photograph (oxycodone CR 5-mg blister pack) on the basis of information highlighted in a screen shot of an electronic medication administration record (order for oxycodone 5 mg). Three different presentations were used to identify the medication in the medication administration record and on the drug label.RESULTS:In phase 1, 10 (28%) of 36 nursing staff members knew what all 4 abbreviations meant, and 14 (39%) correctly classified all 4 abbreviations as indicating a short- or a long-acting medication. In the simulation exercise (phase 2), labelling changes reduced the likelihood of a potential medication administration error.CONCLUSIONS:Most abbreviations used to indicate short- versus long-acting medications were not correctly understood by study participants. Of more concern was the incorrect interpretation of some abbreviations as indicating the opposite release rate (e.g., "ER" interpreted as meaning "emergency release", rather than "extended release", with incorrect classification as a short-acting medication). This evaluation highlighted the potential consequences of using non-intuitive abbreviations to differentiate high-risk medications having different release rates.

To address the growing population of seniors, Alberta Health Services plans to provide 11,700 supportive living resident suites over the next decade. Before finalizing the design standards and guidelines for these facilities, a mock-up residential suite was constructed, outfitted with all necessary furnishings and equipment, and used to evaluate the proposed design. Evaluation of the physical space and accessibility for residents' and clinical tasks were accomplished using simulation, think aloud protocols and extensive debriefing sessions. Scenarios were created that focused on commonly-occurring tasks identified by frontline staff as being problematic for both residents and staff. These scenarios were then carried out by seniors and a variety of healthcare professionals to simulate expected room usage. Evaluation of the scenarios indicated that sufficient space was available in the design; however, areas prone to congestion were also identified. Recommendations to improve the design of the residential suite were made to improve accessibility (of cupboards, light switches and electrical outlets), storage (of power scooters/wheel chairs), and bathroom configuration (of emergency pull cord and grab bar locations).

PURPOSE:In Calgary, each of the three acute-care adult hospitals had different anesthetic medication carts with their own type and layout of anesthetic medications. A number of anesthesiologists moved among the different sites, increasing the potential for medication errors. The objective of this study was to identify the anesthetic medications to include and to determine how they should be grouped and positioned in a standardized anesthesia medication cart drawer.METHODS:A standardized list of medications was established. Next, the anesthesia medication cart drawer was filled and photographed, and a jigsaw puzzle was made from the photograph. Anesthesiologists and anesthesia assistants arranged the jigsaw pieces into an ideal drawer. Participants verbalized their rationale for the position of each puzzle piece. Results were collated and analyzed. A mock drawer was developed and reviewed by department members, and minor modifications were made.RESULTS:A final standardized medication drawer (content and positioning) was developed over 30 months, with agreement from anesthesiologists (n = 12) and anesthesia assistants (n = 3) at the three hospitals. Guidelines for placing each medication in the drawer included grouping them according to order of use, frequency of use, similarity of action, severity of harm from misuse, and lack of similar appearance. A finalized template was used for a standardized drawer and installed in every operating room of the three hospitals.CONCLUSION:Implementation of the standardized medication drawer is expected to reduce the likelihood of medication errors. Future research should include testing the clinical implications of this standardization and applying the methodology to other areas.

To address increasing patient demands and acuity, the Calgary Health Region is renovating the intensive care units (ICU) at three of their adult acute care sites. Before finalizing the design plans, mock-up rooms were created at two of the sites according to several proposed room designs in order to identify potential issues during the design phase of the project. All necessary equipment was included within each of the two mock-up rooms so as to nearly replicate a functioning ICU. Evaluations of equipment, room layout and conflicts were accomplished using patient simulation of a cardiac arrest, an acutely ill patient, a palliative care patient and the admission of a new patient. Digital videos, think aloud audio tracks and extensive debriefing sessions were combined and analyzed. Specific category issues were identified including the articulating arms, visibility of the patient monitors, equipment usability, collisions with equipment, and communication issues. Elaboration of each issue and presentation of design recommendations is given.

Several studies have addressed the need for pharmaceutical companies to improve medication labelling. Criticisms have generally related to small font size, poorly designed and visually cluttered labels, and inadequate warnings. In addition, similarities between medication names (i.e., lookand sound-alike names) and labels (i.e., look-alike packaging), as well as unsafe storage practices, have been cited as contributing to medication incidents and errors. Coupled with research in human factors, this information can prompt and guide health care organizations to improve labelling in medication storage areas. Building on our previous article, which outlined an initiative within the Calgary Health Region to simplify the storage of medications, the current article highlights specific improvements in medication labelling that were made in the inpatient care and pharmacy areas in an effort to enhance safety and improve efficiency.