10/5/2019 Doug Peterson
In a real hospital setting, this team communication must be clear and coordinated, or the consequences can be fatal, says Abigail Wooldridge.
Written by Doug Peterson
Anyone who regularly watches medical dramas on TV knows the drill. In the chaos of an emergency, doctors fire off orders right and left as a team gathers around the patient. In the very first episode of the TV show Grey’s Anatomy, for instance, a patient suddenly goes into convulsions, and the doctor snaps, “Phenobarbital! Load her with phenobarbital!”
No dosage is mentioned—a big mistake, according to a doctor analyzing this particular Grey’s Anatomy scene in an online show. What’s more, he says that in a real situation, the nurse would’ve repeated the exact dose to make sure communication was clearly received.
Handoffs are when the authority, responsibility, and information about a patient are transferred from one set of clinicians to another. This can happen at shift changes, when patients are moved from one health care facility to another, or when they are moved between units within a hospital.
As Wooldridge explains, handoffs are a double-edged sword. “On the positive side, when you have a new group of people starting to take care of a patient, they might realize something was missed, or they may have a new perspective on what should happen for a patient that could improve the quality of care.”
But there are also risks. Information can be lost or missed during handoffs. For example, she says, a clinician might forget to tell the new team that a patient needs a certain dose of a medication.
To study transitions between an operating room and an intensive care unit, Wooldridge is working with the Jump Simulation Center in Peoria. The center has life-sized simulation rooms of both an operating room and an intensive-care unit.
“It’s a high-fidelity simulation,” she says. “It’s a setting that looks like a real operating room and a real intensive care unit.”
Using a child-sized mannequin and working with nurses and doctors at OSF HealthCare in Peoria, Wooldridge will be studying the handoff of a child patient with a penetrating chest trauma.
“The reason we’re focusing on a child is because trauma is the leading cause of death in children and young adults in the United States,” she says. “If we can improve this really important part of their care—the transition—then we can save lives.”
Wooldridge’s team will collect both audio and video recordings of the handoff and will even capture non-verbal communication, including eye movements.
“Eye-tracking data will tell us where people are looking,” Wooldridge says. “When the surgeon is presenting the case, are they looking at the patient or at the surgeon? If people are looking at the same place, they may be more in tune with each other. The team may be more coordinated.”
Wooldridge joined ISE in 2018, so she is just launching this and other health-related projects. She says she has been passionate about medicine ever since her undergraduate years at the University of Louisville, when her original plan was to go into medical school. That’s when she learned something rather important about herself.
She hates blood.
“I’m one of those people who faint at the sight of blood,” she says. She discovered this while doing an observation as somebody was having blood drawn for lab work. “I had to sit down on the floor of the clinic.”
Eight weeks into her first semester, she transferred to industrial engineering, channeling her passion for medicine into engineering. She went on to do her PhD at the University of Wisconsin-Madison, where she studied the impact of sociotechnical system design on “team cognition”—how nurses, physicians, and others work together. She continues this theme at the University of Illinois
In another new project at U of I, she is studying innovative ways to train medical personnel in using a “code cart.”
“This cart on wheels is kept in different places of the hospital, and it’s supposed to have all of the medications and equipment you would need right away to resuscitate a patient—to get them to start breathing or their heart to start beating again,” Wooldridge explains.
Once again, Grey’s Anatomy offers up an example with a scene in which the medical team reacts to an emergency requiring a code cart. The doctor shouts, “I need an ET tube!” But when the intern opens a white drawer in the cart, the doctor barks, “Orange drawer! Orange drawer!”
“I knew that,” the intern says, as she shifts to the orange drawer of the cart.
“As medical TV shows depict, these are high-stress events,” Wooldridge says. “People are working together at a fast pace, and they need to be able to know what is on that cart and where it is, so they can access it without delay. If there’s a delay, the patient can die.”
One complication, she says, is that the equipment needed on a code cart will vary, depending on the size of the patient. A small child will need different size equipment than a teenager. Therefore, OSF HealthCare has decided to move to a new, weight-based pediatric code cart.
“But the question came up: Is there a better way to train our clinicians on where things are on the new code cart?” she says. Engineers at the Jump Simulation Center developed an augmented reality app for cellphones, which they hope can train nurses and doctors to use the new cart. As one of the principle investigators in the study, Wooldridge is doing a usability assessment and exploring the systems-level impact of the new augmented reality app in training personnel.
The app allows you to place a virtual code cart in the middle of any room, making the cart visible on your phone. By interacting with your phone, you can approach the augmented reality cart, open drawers, and remove equipment from the different-colored drawers.
“This is a big change in how we educate people,” Wooldridge says. Currently, nurses and doctors learn by using a real code cart, but she says that quite often the drawers are not fully stocked.
“The augmented reality cart will have everything, and that’s a big change,” she says. “Also, we’re going from a learning process where people are together and talking in real time face-to-face to a process that is mediated completely by technology. People are not communicating directly and they’re not together, and we think this will have a big impact on the learning environment.”
Wooldridge plans to develop surveys to assess the satisfaction, usability, and usefulness of the new teaching tool. She will also lead focus groups on how the teaching app might change the tasks associated with learning and how policies and procedures for this educational system need to be changed.
This study reflects Wooldridge’s chief focus at ISE—an area known as human factors and ergonomics, which focuses on how to fit a system, environment, or technology to humans.
She points out that “at each stage of the patient journey, there are interactions that happen with the health care system and with different tools and technologies, like electronic health records. And those interactions involve a team. We’re addressing team cognition all along that path, trying to improve it.”
But patients may not be the only ones to benefit from these improvements.
“This might also improve outcomes for the providers,” she says. “It might reduce clinicians’ stress, decrease their burnout, and increase their job satisfaction. So this would be a win-win.”