Presentation
Massive Hemorrhage Protocol: Applying Human Factors to Digitizing Critical Hospital Workflows
DescriptionThe University Health Network (UHN) in Toronto launched the implementation of a new health information system (HIS) on June 4th, 2022. The shift to a singular digital system from the decades-long reliance on a combination of paper-based workflows and older EHR systems aimed to enhance healthcare delivery for both patients and providers. The Massive Hemorrhage Protocol (MHP) is initiated when a patient is experiencing massive blood loss at an incredibly rapid rate. Patients typically require urgent transfer to a critical care unit and the patient’s physician is responsible for informing the Blood Transfusion Laboratory immediately. Clinicians must also contact the hospital’s Blood Bank for ordering required blood products. The MHP consists of a complex interplay of many different teams and staff members – physicians, nurses, code responders, blood bank technologists, and so on – who are each responsible for completing the necessary steps of the overall workflow in tandem whilst also ensuring optimal treatment of the patient. The MHP is an example of the UHN’s use of a hybrid digital and paper-based system, particularly in a high-risk and increased criticality clinical environment. The MHP did not undergo a complete digital transformation during the HIS implementation at the UHN, and instead was transitioned into a hybrid workflow consisting of both paperwork and digital input tasks. It remained as such until later in 2022 when the UHN decided to adopt a fully electronic workflow that retained the necessary tasks of the paper-based system, including but not limited to positive patient identification, blood product checks, blood transfusion documentation, etc.
Given the complexity and criticality of the MHP workflow, there was a desire to incorporate a human factors informed approach to digitizing the workflow. As a result, Healthcare Human Factors (HHF) played a significant role in reviewing iterations of the MHP user interface and conducting a series of usability evaluations on the proposed MHP, analyzing the tasks that providers must perform to carry out the new protocol successfully, as well as those that the blood bank technicians must complete as an instrumental part of the process.
During the month of January 2023, HHF led two human factors evaluations to validate the use-safety, efficiency and usability of the New Massive Hemorrhage Protocol (MHP) workflow and digital order sets. Our overall human factors approach began by conducting current state workflow research followed by the rapid usability simulation. Our team performed observations and interviews in different clinical units across Toronto General Hospital and Toronto Western Hospital. Specifically, our observations within the Emergency Department (ED) and Intensive Care Units (ICUs) were instrumental in gaining insights and familiarity of workflow order, decision-making roles and rationales, interactions, constraints, knowledge requirements, distinct responsibilities among staff, etc.
The usability simulations recruited representative and intended users to assess the use-safety and ease of use of the proposed electronic MHP prior to its implementation into official UHN practice. The first study focused on the roles and responsibilities of physicians and nurses during the proposed MHP workflow. In particular, the study intended to observe their interactions with the new MHP order sets, as well as ascertain how their interdependent roles during an MHP are sustained and affected by the proposed electronic MHP. The second study concentrated on the role of blood bank technicians in the current state MHP versus the changes in the workflow as a direct result of the newly proposed MHP.
The presentation will consist of an introduction to the HIS implementation at the UHN to provide context and will primarily discuss the Massive Hemorrhage Protocol’s transformation from a paper-based to hybrid to fully electronic workflow. Furthermore, the presentation will share the scope, methodologies, and key learnings of both human factors studies conducted by HHF. By elaborating on the methodologies and learnings, we hope to convey the impact of assessing the use-safety and usability of this incredibly critical workflow, and the importance of considering and collaborating with the many cross-functional teams and healthcare providers involved in an MHP. Additionally, we intend to provide insight into the use issues observed and their root causes, the features of the proposed MHP that were cause for concern among users, the design recommendations provided by our team and the eventual no-go decision made by the UHN upon reviewing our human factors usability report.
Given the complexity and criticality of the MHP workflow, there was a desire to incorporate a human factors informed approach to digitizing the workflow. As a result, Healthcare Human Factors (HHF) played a significant role in reviewing iterations of the MHP user interface and conducting a series of usability evaluations on the proposed MHP, analyzing the tasks that providers must perform to carry out the new protocol successfully, as well as those that the blood bank technicians must complete as an instrumental part of the process.
During the month of January 2023, HHF led two human factors evaluations to validate the use-safety, efficiency and usability of the New Massive Hemorrhage Protocol (MHP) workflow and digital order sets. Our overall human factors approach began by conducting current state workflow research followed by the rapid usability simulation. Our team performed observations and interviews in different clinical units across Toronto General Hospital and Toronto Western Hospital. Specifically, our observations within the Emergency Department (ED) and Intensive Care Units (ICUs) were instrumental in gaining insights and familiarity of workflow order, decision-making roles and rationales, interactions, constraints, knowledge requirements, distinct responsibilities among staff, etc.
The usability simulations recruited representative and intended users to assess the use-safety and ease of use of the proposed electronic MHP prior to its implementation into official UHN practice. The first study focused on the roles and responsibilities of physicians and nurses during the proposed MHP workflow. In particular, the study intended to observe their interactions with the new MHP order sets, as well as ascertain how their interdependent roles during an MHP are sustained and affected by the proposed electronic MHP. The second study concentrated on the role of blood bank technicians in the current state MHP versus the changes in the workflow as a direct result of the newly proposed MHP.
The presentation will consist of an introduction to the HIS implementation at the UHN to provide context and will primarily discuss the Massive Hemorrhage Protocol’s transformation from a paper-based to hybrid to fully electronic workflow. Furthermore, the presentation will share the scope, methodologies, and key learnings of both human factors studies conducted by HHF. By elaborating on the methodologies and learnings, we hope to convey the impact of assessing the use-safety and usability of this incredibly critical workflow, and the importance of considering and collaborating with the many cross-functional teams and healthcare providers involved in an MHP. Additionally, we intend to provide insight into the use issues observed and their root causes, the features of the proposed MHP that were cause for concern among users, the design recommendations provided by our team and the eventual no-go decision made by the UHN upon reviewing our human factors usability report.
Event Type
Oral Presentations
TimeTuesday, March 261:30pm - 1:50pm CDT
LocationSalon A-1
Hospital Environments