Emergency evacuations are dynamic, time-critical events involving complex coordination decisions. To develop robust evacuation policies, it is important to understand how people respond to evacuation alerts, including choices of time to leave and routes to take. The purpose of this study was to investigate the preferred communication sources and modalities for evacuees to use and learn about changes in hurricane scenarios. A hurricane evacuation behavior survey was administrated to residents in the greater Charleston, South Carolina, area. In this study, two hurricane scenarios are examined to understand prehurricane evacuation decisions and communication preferences of residents. Results from the survey indicate that while driving, respondents prefer using radios to gather traffic and weather information. When at home, television is the most preferred modality among respondents to determine weather status and to find out about hurricane evacuation notices. Concerning evacuation behavior, respondents prefer leaving in the daytime rather than at night. To account for this preference, evacuation announcements and notifications should be broadcast early enough to allow for more daytime evacuations. This may result in a longer lead time if the announcement would have otherwise occurred at night. The evacuation timing decisions from the survey are then compared with historical behavior data from a retrospective Hurricane Hugo survey. The respondents indicate a tendency to evacuate earlier than what was shown in the Hurricane Hugo survey. This may imply that it takes longer to actually prepare to leave than respondents to the current survey realize. Alternatively, respondents to the Hurricane Hugo survey may pay more attention to weather patterns as well as wait for orders to be provided by the state rather than make a proactive decision to leave. (C) 2013 American Society of Civil Engineers.

Inter-staff communication plays a significant role on the efficiency of healthcare delivery and on patients’ health outcomes; however, previous studies focused on communication and its associated effects at facilities, such as resident-centered long-term care settings, are extremely limited. The current survey study investigates inter-staff communication characteristics and patterns based on staff's roles and responsibilities in a culture-changed nursing home. ‘Timeliness’, ‘accuracy’, ‘understanding’, ‘effectiveness’, and ‘openness’, five dimensions of communication quality, are used to evaluate staff's preferred communication modalities and behaviors. Results found that 28.3% of respondents have more than one role or responsibility. Therefore, strategies for communication modalities and qualities vary accordingly. Among different modalities, synchronous communication modalities were most preferred to achieve the five communication quality dimensions in all groups, but there were significant differences between roles when using the asynchronous modalities to achieve understandable and effective communication. In conclusion, management should serve as a mediator in setting up a series of communication policies that not only achieve communication quality within a facility and satisfy staff's communication preferences, but also maintain efficient operational workflow and residents’ quality of life in the resident-centered long-term care facility.

Medication administration is an increasingly complex process that requires adaptability by nurses. In this study, twenty-one observational sessions of the medication administration process were conducted on a Medical/Surgical unit, and the processes used by nurses were analyzed to discover systemic process variability and determine possible best practices. When nurses instituted a patient medication order and medication review cycle prior to the other activities associated with medication administration, it was more likely that discrepancies in physician orders, electronic medication administration records, and missing medications would be mitigated within the same medication pass.Relevance to industry: This research specifically investigates the process flows involved in medication administration This work is a starting point in an effort to establish industry best practices and to identify the variables, such as technology use, facility layout, and process interruptions, which impact their standardization. (C) 2011 Elsevier B.V. All rights reserved.

This study is devoted to recognizing the breathing resistances of wearing respirators from respiratory and surface electromyography (sEMG) signals. Ten subjects were required to sit for 5 min and walk for 5 min while wearing two different models of N95 filtering facepiece respirators (FFRs) and without a respirator. We recorded the sEMG signals from the respiratory muscles of the subjects, and the respiratory amplitude is also collected. Subsequently, fifteen features of the sEMG time domain and respiratory amplitude were extracted and used as input vectors to a recognition model based on artificial neural networks (ANNs). Finally, the experimental results show that these artificial neural networks are effective for recognizing different airway resistances of wearing respirators from sEMG and respiratory signals. The results also indicate that abdominal and scalene are the primary respiratory muscles affected by using N95 FFRs.Respirator manufactures and administrations can readily employ this paper's findings for recognizing the breathing resistances of wearing respirators from respiratory and surface electromyography (sEMG) signals based on artificial neural networks automatically. Observations of the present study are in support of testing only the two primary muscles (abdominal and scalene) to simplify the evaluation of the effects of the breathing resistances of wearing respirators on respiratory muscles.

Preventable patient harm due to errors in medication ordering, transcribing, dispensing and administration is a significant problem as discussed in the Institute of Medicine's 2007 report “Preventing Medication Errors”. Additionally, the report states that there are “enormous gaps in the knowledge base with regard to medication errors” and that the current methods available to solve this problem are inadequate (IOM, 2007, p2). Consequently, human factors research can contribute to the solution for this national problem by addressing the complexity in current medication systems and by designing user-centered solutions that support the real complex cognitive work of the clinicians. Panelists in this session, who have been funded by the federal government, private industry, and fellowships, will briefly share their human factors research on medication systems and then discuss how human factors researchers and practitioners can contribute to medication safety goals.

The healthcare crisis in the United States has prompted the Institute of Medicine [IOM] and National Academy of Engineering [NAE] to collaborate to address how systems engineering could be used to redesign processes and delivery systems in healthcare. A collaborative effort funded by Robert Wood Johnson Foundation, the National Science Foundation, NIH, and NAE, brought together engineers and healthcare professionals to examine engineering applications and systems engineering tools as they apply to the healthcare system. The full report, Building a Better Delivery System: A New Engineering/Health Care Partnership, outlines several recommendations to close the growing gap. In response the Clemson University-GHS partnership demonstrates how systems engineering principles can be used. In this research, the authors present several concurrent research efforts being pursued as a partnership between Greenville Hospital System and Clemson University, and variety of tools that can be used to study and solve complex issues faced in healthcare. In particular, the authors suggest where both human factors and quantitative systems modeling can be used to provide insight and recommendations for changing existing processes.

The objective of this research was to develop an empirically supported language for describing strategies and processes that healthcare providers utilise to obtain, share and use resources during healthcare delivery. A combination of observational data from clinical providers and reviews of prior literature in the resource foraging domain have resulted in an improved theoretical framework of multidimensional resource foraging. Results of the literature review indicate that existing theories of resource foraging and previous medical literature on taxonomies of healthcare provider tasks are insufficient to describe the demands and requirements for team-based, event-driven, healthcare task coordination. This improved framework provides a significant advance in both the methodology and measurement of resource foraging, and patient care task coordination among providers across a range of healthcare settings.

This review paper addresses issues in how healthcare providers search, obtain, and share resources in provider teams. Based in part on a System of Systems (SoS) analysis of provider coordination and resource flows, this paper expands the concepts of resource foraging theory and event dynamics to develop systematic methods for studying healthcare provider coordination. Process flow and human factors emphases from industrial engineering are used to address critical concerns of single-scale and multi-scale performance in healthcare delivery settings. Provider strategies for acquiring the information and resources needed for successful healthcare delivery are dependent on interactions between task requirements, time constraints, and provider coordination processes, as well as limitations of information and resource flow capabilities. These improved definitions and measures will enhance engineers' ability to contribute to improved patient care timeliness, effectiveness, quality, and safety.

Medication administration is an increasingly complex process, influenced by the number of medications on the market, the number of medications prescribed for each patient, new medical technology and numerous administration policies and procedures. Adverse events initiated by medication error are a crucial area to improve patient safety. This project looked at the complexity of the medication administration process at a regional hospital and the effect of two medication distribution systems. A reduction in work complexity and time spent gathering medication and supplies, was a goal of this work; but more importantly was determining what barriers to safety and efficiency exist in the medication administration process and the impact of barcode scanning and other technologies. The concept of mobile medication units is attractive to both managers and clinicians; however it is only one solution to the problems with medication administration. Introduction and Background Medication administration is an increasingly complex process, influenced by the number of medications on the market, the number of medications prescribed for each patient, and the numerous policies and procedures created for their administration. Mayo and Duncan (2004) found that a “single [hospital] patient can receive up to 18 medications per day, and a nurse can administer as many as 50 medications per shift” (p. 209). While some researchers indicated that the solution is more nurse education or training (e.g. see Mayo & Duncan, 2004; and Tang, Sheu, Yu, Wei, & Chen, 2007), it does not appear that they have determined the feasibility of this solution and the increased time necessary to look up every unfamiliar medication. Most of the research which focuses on the causes of medication errors does not examine the processes involved in the administration of the medication. And yet, understanding the complexity in the nurses’ processes and workflow is necessary to develop safeguards and create more robust systems that reduce the probability of errors and adverse events. Current medication administration processes include many \ tasks, including but not limited to, assessing the patient to obtain pertinent data, gathering medications, confirming the five rights (right dose, patient, route, medication, and time), administering the medications, documenting administration, and observing for therapeutic and untoward effects. In studies of the delivery of nursing care in acute care settings, Potter et al. (2005) found that nurses spent 16% their time preparing or administering medication. In addition to the amount of time that the nurses spent in preparing and administering medication, Potter et al found that a significant number of interruptions occurred during this critical process. Interruptions impact the cognitive workload of the nurse, and create an environment where medication errors are more likely to occur. A second environmental factor that affects the nurses’ workflow, is the distance traveled to administer care during a shift. Welker, Decker, Adam, & Zone-Smith (2006) found that on average, ward nurses who were assigned three patients walked just over 4.1 miles per shift while a nurse assigned to six patients walked over 4.8 miles. As a large number of interruptions (22%) occurred within the medication rooms, which were highly visible and in high traffic locations (Potter et al., 2005), and while collecting supplies or traveling to and from patient rooms (Ebright, Patterson, Chalko, & Render, 2003), reducing the distances and frequency of repeated travel could have the ability to decrease the number of interruptions and possibly errors in medication administration. Adding new technology, revising policies and procedures, and providing more education have often been the approaches taken to reduce medication errors. Unfortunately these new technologies, such as computerized order entry and electronic medical records / charting, and new procedures, for instance bar code scanning both the medicine and the patient, can add complexity to the nurse’s taskload. The added complexity in correspondence with the additional time necessary to complete the additional steps can lead to workarounds and variations in care. Given the problems in the current medication administration processes, this work focused on facilitating the nurse’s role in the medication administration process. This study expands on the Braswell and Duggar (2006) investigation and compares processes at baseline and postintroduction of a new mobile medication system. To do this, the current medication administration and distribution process was fully documented to determine a baseline in workload complexity. Then a new mobile medication center was installed to allow nurses easier access to patient medications while traveling on the floor, and the medication administration and distribution process was remapped to demonstrate where process complexities were reduced and nurse workflow is more efficient. A similar study showed that the time nurses spend gathering medications and supplies can be dramatically reduced through this type of system (see Braswell & Duggar, 2006); however, they did not directly investigate the impact on the nursing process. Thus, this research is presented to document the impact of this technology on the nursing workflow at a regional hospital, and as an expansion on the work begun by Braswell and Duggar.

Looking at expertise from the vantage point of many knowledge domains allows the observations and resulting definitions to be useful across a broad range of subject areas. A stable set of definitions that work on a higher, more comprehensive level than the current literature offers is needed for an integrated description of expertise. A cohesive cross-domain definition and explanation of expertise can be used to optimise group interactions. Since group performance incorporates additional components of expertise that are not present in individual performance situations, these additional components must be examined in order to see a full picture of the successful utilisation of expertise in a group setting. This expanded expertise definition will allow group dynamics to be better understood and will help break down the expertise components required to have successful group interactions.

Distributed product development teams require integration of expertise from multiple technical disciplines and, in some companies, geographical and organizational diversity as well. Systems engineering methodologies can be applied to measure and support the effectiveness of knowledge sharing in complex, time sensitive development environments. In addition, effective knowledge sharing can reduce the incidence of failed coordination and adverse events. In this paper, three conceptual frameworks are proposed to help address these issues. Concepts of knowledge clusters, multiple dimensions of expertise, and information foraging are shown to affect structure, process and timing of team behaviors and project outcomes. These frameworks provide systematic analysis and usable knowledge sharing tools to coordinate knowledge transfer across expertise boundaries within a product development team. Specific methods can be used to move information across these boundaries to improve information alignment and organizational efficiency.

Significant concerns exist over the ability of the healthcare and public health systems to meet the surge demands that would result from an event such as an influenza pandemic. Current guidance for public health planners is largely based on expert opinion and may lack connection to the problems of street-level public health practice. To identify the problems of local planners and prepare a state-level planning template for increasing health care surge capacity that accounted for these issues, a study was conducted of local pandemic planning efforts in thirteen counties, finding that cognitive biases, coordination problems, institutional structures in the healthcare system, and resource shortfalls are significant barriers to preparing and implementing a surge capacity plan. In addition, local planners identify patient demand management through triage and education efforts as a viable means of ensuring adequate capacity, in contrast to guidance proposing an increased supply of care as a primary tool.

Garrett, Sandra Kay Powers. Ph.D., Purdue University, May 2007. Provider Centered Coordination, Resource Foraging, and Event Management in Healthcare Tasks. Major Professor: Barrett S. Caldwell The increasing complexity of healthcare and recent awareness of deaths and injuries associated with system errors has made patient safety an issue of national concern. Improving the quality and efficiency of the U.S. healthcare delivery system is a major theme in healthcare engineering, including the research presented in this dissertation. This research was focused on the task and resource needs of healthcare providers in clinic-based healthcare delivery. The original purpose of this study was to investigate how and when healthcare providers seek the information and resources necessary to deliver effective patient care, but it quickly branched out to incorporate more global goals of how to describe and improve the medical provider team’s ability to provide better and more efficient care to patients. The evolved dissertation defined and interpreted the concept of foraging theory in the context of healthcare providers’ strategies; expanded the definition of foraging to include dimensions essential in dynamic, event-driven, timecritical settings; and refined the definition of an event and associated deadline dynamics in team-based dynamic tasks.

Although applied in a number of fields (including information science and human-computer interaction), foraging theory has not been used to study role differentiated team dynamics in an event driven environment. Many critical assumptions must be modified and the operational definitions must be enhanced for the theory to be applied in these more complex settings. This paper focuses on research developments leading to conceptual elaborations and expansions of the resource foraging framework, in order to address team-based resource acquisition and utilization strategies. The additional foraging concepts and definitions presented in this paper derive from the authors' research in spaceflight operations and healthcare delivery environments. In the authors' current healthcare research, appropriate resource foraging strategies vary dramatically based on specific healthcare setting, team structure, and other factors. These findings help to empirically validate the expanded construct of resource foraging by teams.

In healthcare, the team of medical providers must cooperatively seek the information and physical resources needed in order to be able to attend to patients in a timely and effective manner. Foraging theory is one field that may help describe the strategies used to acquire resources; however, the concept and definitions of foraging must be expanded to appropriately describe the team coordination activities in a high-risk, time-limited, event-driven environment. The issues of resource handoffs and the coordination of multiple task demands with shifts between tasks become crucial to the overall performance of the healthcare delivery system. Task interleaving and parallel work load issues are being investigated to distinguish these actions from the issue of workload interruptions emphasized in previous research.

Users often come to websites with a specific type of purpose or goal, which defines how the user interacts with the site. Two types of task-goals addressed in this study include general browsing and specific information seeking. Likewise, the design and organization of different websites can facilitate different user goals. User satisfaction and frustration from interacting with a particular website depends on the compatibility between the website design and the user's type of goal. This study applies simulation techniques to investigate how the compatibility between user goals and website design impacts user satisfaction and frustration levels. The simulation results show that navigation tools that increase compatibility versus attractiveness (the increased likelihood of use) have a greater impact on customer satisfaction and could in turn maximize the effectiveness of website usage.