Presentation
Telemazing Collaboration: A Multiple Hospital Working Group to Develop Human Factors Guidelines for Centralized Cardiac Telemetry Monitoring
DescriptionBackground
The advent of continuous cardiac telemonitoring into healthcare settings has introduced numerous complexities to clinical work. At the 2022 Human Factors Healthcare Symposium, several presentations identified issues including the excessive workload of telemetry technicians due to patient load, the arrangement of telemonitoring screens and the impacts on telemetry technicians’ attention (Nystrom et al., 2023, Peng et al., 2023). Conversations between embedded healthcare human factors practitioners ensued after these presentations and, despite differing institutions, many of us recognized we were struggling with the same problems introduced by telemetry in hospital environments (Jamil, 2020, Sanghavi, 2022). The purpose of this panel is two-fold. First, we will tell our collaboration story as a group of embedded human factors professionals who are working across institutions to develop general guidelines to encourage the safe implementation of telemetry into different hospitals. Second, we will share our draft telemetry guidelines with the audience to elicit their expert feedback.
Importance
There are broad patient safety implications tied to the successful design of telemetry work. Not only are there issues related to workload and attention as previously highlighted, but many other contributing factors that human factors engineering is positioned well to address including: staff interruptions, communication, alarm parameters and alarm fatigue, and design for usability in the telemetry hardware and software systems.
Definitions
Telemetry monitoring (tele) is a method of observing a patient’s cardiac rhythms and other physiological characteristics via electrodes attached to the patient’s chest and a portable monitor. The heart rhythm waveforms and other monitored information is transmitted to large screen monitors. These monitors are usually located at the nurse’s station, and with centralized monitoring, monitors are located in a monitor room somewhere else in the hospital or offsite. With centralized monitoring, telemetry technicians watch the physiologic data and contact patient care team members about patient changes.
Methods
• A working group of international healthcare system-embedded human factors practitioners assembled at the 2023 HFES Healthcare Symposium and leveraged the Human Factors Transforming Healthcare (HFTH) Network to help connect with other interested practitioners not present at the conference. Five healthcare systems are represented in the working group.
• First, members of the group identified the major issues in their telemetry systems and compiled them onto Miro, a collaborative whiteboard platform.
• We then performed an affinity diagramming session to identify common themes of issues faced by healthcare systems in implementing telemetry.
• The themes were further developed and discussed by the group and broken down into individual issues.
• The group then started developing guidelines for applying human factors and systems engineering principles to address each issue identified.
• The goal of the group is to develop guidelines, further refine these guidelines, and then use existing rating systems to rate the strength of the guidelines based on existing literature and research.
Results & Discussion
• The affinity diagramming session identified the following themes of issues with telemetry implementation: Software Usability, Environmental Design of the System, and Organizational Policy.
• We will share our guideline to date with the audience.
• As a follow up to this session, we plan to continue to refine our guideline, incorporate additional clinical perspectives, and aim to publish for broader use by other health systems.
References
Jamil, M. (2020, May 18-21). Don't Miss a Beat: Understanding Complex System Factors to Improve Cardiac Telemetry Patient Safety [Conference Presentation]. 2020 International Symposium on Human Factors and Ergonomics in Health Care, Virtual Symposium. https://higherlogicdownload.s3.amazonaws.com/HFES/42fffbb4-31e1-4e52-bda6-1393762cbfcd/UploadedImages/2020_HCS/Health_Care_Symposium_Program_as_of_May_15_2020.pdf
Nare, M.T. & Hancock, G.M. (2021, April 12-16). Vigilance in cardiac telemetry monitoring: Performance outcomes and effects on operators’ cognitive and affective states. 2021 International Symposium on Human Factors and Ergonomics in Health Care, Virtual Symposium.
Nystrom, D., Thomas, J., Jones, C. (2023, March 26-29). Preliminary Evaluation of Cardiac Telemetry Technician Work in a Large Health System: Mutual Dependence and Considerations for Patient Load [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Peng, Y., Sanghavi, H., Jesso, M., Wolf, L. (2023, March 26-29). Everything, Everywhere, All at Once: Remote Telemetry Monitoring Performance (Response Time, Error Rate and Perceived Workload). [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Sanghavi, H., Peng, Y., Jesso, M., Wolf, L. (2022, March 20-23). Remote Telemetry Monitoring Task: obtaining Baseline Performance. [Conference Presentation]. 2022 International Symposium on Human Factors and Ergonomics in Health Care, New Orleans, LA, United States. https://www.hcs-2023.org/_files/ugd/3b7267_988d4fc94a99409aa0c5deafd6cb8100.pdf
The advent of continuous cardiac telemonitoring into healthcare settings has introduced numerous complexities to clinical work. At the 2022 Human Factors Healthcare Symposium, several presentations identified issues including the excessive workload of telemetry technicians due to patient load, the arrangement of telemonitoring screens and the impacts on telemetry technicians’ attention (Nystrom et al., 2023, Peng et al., 2023). Conversations between embedded healthcare human factors practitioners ensued after these presentations and, despite differing institutions, many of us recognized we were struggling with the same problems introduced by telemetry in hospital environments (Jamil, 2020, Sanghavi, 2022). The purpose of this panel is two-fold. First, we will tell our collaboration story as a group of embedded human factors professionals who are working across institutions to develop general guidelines to encourage the safe implementation of telemetry into different hospitals. Second, we will share our draft telemetry guidelines with the audience to elicit their expert feedback.
Importance
There are broad patient safety implications tied to the successful design of telemetry work. Not only are there issues related to workload and attention as previously highlighted, but many other contributing factors that human factors engineering is positioned well to address including: staff interruptions, communication, alarm parameters and alarm fatigue, and design for usability in the telemetry hardware and software systems.
Definitions
Telemetry monitoring (tele) is a method of observing a patient’s cardiac rhythms and other physiological characteristics via electrodes attached to the patient’s chest and a portable monitor. The heart rhythm waveforms and other monitored information is transmitted to large screen monitors. These monitors are usually located at the nurse’s station, and with centralized monitoring, monitors are located in a monitor room somewhere else in the hospital or offsite. With centralized monitoring, telemetry technicians watch the physiologic data and contact patient care team members about patient changes.
Methods
• A working group of international healthcare system-embedded human factors practitioners assembled at the 2023 HFES Healthcare Symposium and leveraged the Human Factors Transforming Healthcare (HFTH) Network to help connect with other interested practitioners not present at the conference. Five healthcare systems are represented in the working group.
• First, members of the group identified the major issues in their telemetry systems and compiled them onto Miro, a collaborative whiteboard platform.
• We then performed an affinity diagramming session to identify common themes of issues faced by healthcare systems in implementing telemetry.
• The themes were further developed and discussed by the group and broken down into individual issues.
• The group then started developing guidelines for applying human factors and systems engineering principles to address each issue identified.
• The goal of the group is to develop guidelines, further refine these guidelines, and then use existing rating systems to rate the strength of the guidelines based on existing literature and research.
Results & Discussion
• The affinity diagramming session identified the following themes of issues with telemetry implementation: Software Usability, Environmental Design of the System, and Organizational Policy.
• We will share our guideline to date with the audience.
• As a follow up to this session, we plan to continue to refine our guideline, incorporate additional clinical perspectives, and aim to publish for broader use by other health systems.
References
Jamil, M. (2020, May 18-21). Don't Miss a Beat: Understanding Complex System Factors to Improve Cardiac Telemetry Patient Safety [Conference Presentation]. 2020 International Symposium on Human Factors and Ergonomics in Health Care, Virtual Symposium. https://higherlogicdownload.s3.amazonaws.com/HFES/42fffbb4-31e1-4e52-bda6-1393762cbfcd/UploadedImages/2020_HCS/Health_Care_Symposium_Program_as_of_May_15_2020.pdf
Nare, M.T. & Hancock, G.M. (2021, April 12-16). Vigilance in cardiac telemetry monitoring: Performance outcomes and effects on operators’ cognitive and affective states. 2021 International Symposium on Human Factors and Ergonomics in Health Care, Virtual Symposium.
Nystrom, D., Thomas, J., Jones, C. (2023, March 26-29). Preliminary Evaluation of Cardiac Telemetry Technician Work in a Large Health System: Mutual Dependence and Considerations for Patient Load [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Peng, Y., Sanghavi, H., Jesso, M., Wolf, L. (2023, March 26-29). Everything, Everywhere, All at Once: Remote Telemetry Monitoring Performance (Response Time, Error Rate and Perceived Workload). [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Sanghavi, H., Peng, Y., Jesso, M., Wolf, L. (2022, March 20-23). Remote Telemetry Monitoring Task: obtaining Baseline Performance. [Conference Presentation]. 2022 International Symposium on Human Factors and Ergonomics in Health Care, New Orleans, LA, United States. https://www.hcs-2023.org/_files/ugd/3b7267_988d4fc94a99409aa0c5deafd6cb8100.pdf
Event Type
Discussion Panel
Oral Presentations
TimeTuesday, March 2610:50am - 12:00pm CDT
LocationSalon A-1
Hospital Environments