Posted below are links to some interesting work in the domain.
Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology of medical error. BMJ. 2000;320(7237):774–7
I found that Weingart et al. in this work provide a good introduction to the topic of medical error, highlighting the impact errors can have on patient outcome. The paper also discusses the types of errors that have occurred in the literature, in addition to an analysis of impact of clinician experience on error occurrence.
The rest of the papers discuss methods by which workflow is monitored. One of my research aims is to develop a method that combines qualitative and quantitative techniques to enhance workflow monitoring.
Malhotra S, Jordan D, Shortliffe E, Patel VL. Workflow modeling in critical care: Piecing together your own puzzle. Journal of Biomedical Informatics. 2007;40(2):81-92.
Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care. International Journal of Medical Informatics. 2007;76(11-12):801-11.
Malhotra et al. and Laxmisan et al. have utilized qualitative methods (observations, interviews, chart analysis) for analyzing workflow in critical care units. Some of the advantages of qualitative techniques (high quality of information gathering) are evident in these works.
Fry EA, Lenert LA. MASCAL: RFID tracking of patients, staff and equipment to enhance hospital response to mass casualty events. AMIA Annual Symposium Proceedings.
2005:261-5
Chen C, Liu C, Li Y, Chao C, Liu C, Chen C, et al. Pervasive Observation Medicine: The Application of RFID to Improve Patient Safety in Observation Unit of Hospital Emergency Department. IOS Press; 2005.
Fry and Lenert, and Chen et al. present some exciting research of incorporating RFID in the healthcare setting to impact workflow.
Looking forward to your feedback on these papers!
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Mithra,
ReplyDeleteThese are great. Given the current pressure on the health care system to reduce costs, I think the the focus on errors and outcomes is vital. In fact, I think a framework for identifying and logging such errors/outcomes could potentially be used to evaluate competing modalities as well as surgical and support personnel. For example, this could facilitate a comparison between outcomes/errors of traditional MIS procedures vs robot counterparts. Based on the cost/benefits analysis given the outcomes/errors info, this could objectively evaluate which modality is better. i.e., is Robotics really worth the cost? Given the $10 Billion in potential spending in the health care area, this kind of work would very quickly rise up to the top, eh?
Any thoughts about a framework or database that could track such data? Here at BRL I came up with the "surgical genome project" (I'm still looking for a better name) that attempts to consolidate skills performance data. We've discussed how we could introduce errors and outcomes quite a lot, but there are a lot of challenges, not the least of which is lack of automation relative to tool-path data collection, or even video. I think a single framework that could incorporate both would be invaluable.
Hawkeye's Cyber Physical Systems (CPS)work could potentially address this. Hawkeye, any what do you think...any comments?
Mithra, Nice work.