Presentation
MDD4 - A Tale of Two Trays: Comparing the Information Processing Approach and the Ecological Approach in Anesthesia Tray Design
DescriptionThe location of medications within an anesthesia tray has been identified as one method to reduce the occurrence of perioperative medication errors and improve the efficiency of selecting medications from the tray (Shultz et al., 2010; Wahr et al., 2016). Previous work by Shultz et al. (2010) utilized human factors principles from an information processing perspective to guide the redesign of an anesthesia medication drawer to obtain these benefits. In the present work, these previous contributions were not discovered prior to the team undergoing the redesign of an anesthesia tray utilizing a cognitive engineering frame and concepts familiar to ecological psychology. What initially was an oversight of the present research endeavor now provides an interesting opportunity to compare differences in the resulting designs of anesthesia trays wrought from an information processing approach and an ecological approach.
Methods
Information processing approach:
To correct limitations in perception, mental models, attention and memory, Shultz et al. (2010) reference design guidelines from human factors literature to construct and standardized the anesthesia tray. They also implemented a photographic survey to visualize the anesthesia carts used in the healthcare system, a questionnaire to add or remove medications to include in the anesthesia tray, and a “jigsaw” method where anesthesiologists arranged photos of different medication compartments to where they felt was most relevant for anesthesia work. Afterwards they constructed a mock anesthesia tray to elicit feedback from anesthesiologists about the arrangement of medications in the tray.
Ecological approach:
From an ecological perspective, the principle of information being nested in superordinate and subordinate units within an environment and acknowledgement that the invariant structure produced by the relationship between units helps to guide perception and action, was evoked to create a prototype anesthesia tray for Intermountain Health (Gibson, 1980).
Methods of our design process included 1) reviewing anesthesia charts to assess the order in which medications are administered in perioperative settings, 2) interviews and conversations with anesthesiologists and pharmacists to elicit their feedback about the design of the tray and iteration of the design based on their feedback, and 3) user testing of the newly designed tray as compared to the current tray (pending).
Results
Table 1 provides the comparison of anesthesia trays produced from an information processing approach – adopted by Shultz et al. (2010) – and an ecological approach. Specifically, Table 1 outlines the resulting tray features included in one or both tray designs and – where applicable – a brief description of the differences in how each tray feature was executed in the final tray design according to the information processing approach and ecological approach. (Due to limitations of the submission site that did not allow for the table to be displayed in the correct format, we have opted for a brief example of the contents of the table in plain text format below. "|" indicates separation of columns).
Table 1
Tray Feature | Information processing | Ecological approach
Group medications by function | NA | NA
Isolate potent medications | Positioned “dangerous” medications in back of tray | High potency and “other” medications placed in back of tray
Color-coding and use of patterns | Checkerboard pattern added to distinguish dangerous medications | Color and patterns added to compartment backgrounds to assist with discriminability between medication groups
Gradation of color and patterns | Not available | Color and pattern gradation added to assist with distinguishing potency of medications within groups
Alignment with workspace outside of anesthesia tray | Not available | Relocation of controlled substances tray to align with the new anesthesia tray design
Discussion
Results suggest there are some similarities, but numerous differences in the anesthesia trays designed from an information processing approach and an ecological approach. Tray features that were implemented in the same fashion between the two trays demonstrate the common ground shared by these projects – both were attempting to design a tray that will improve anesthesiologists’ ability to quickly and accurately select medications.
Though a combination of factors are likely at play to determine the execution or inclusion of any/all of the design features listed in Table 1, some can more readily be explained by a difference in the approach that is taken. For instance, Shultz et al. (2010) avoidance of using colored tray compartment backgrounds in an effort to draw more attention to the labels of each vial of medication could be viewed as a function of an information processing approach that increases salience of important information by reducing the visual unification of medication groups. From an ecological approach, including color and patterns in compartment backgrounds not only unifies medications as a group, but creates an affordance that can assist anesthesiologists’ ability to discriminate medication groupings, recognize the potency of medications within groups, and provide structure to help guide their attention while using the tray.
Another difference offered by the ecological approach that was potentially out-of-scope of the information processing lens, was the recognition that the medication tray works in concert with other components that compose the “whole” anesthesiologist work environment. In the present project, this recognition resulted in relocating the controlled substances bin – which is separate than the redesigned tray – to the left-side of the redesigned anesthesia tray because they serve the same function as induction agents. In essence, the ecological approach allowed for expansion of the logic of the tray (i.e., grouping and medications being positioned in order of chronologic use) to aspects of the anesthesiologist’ work environment that are outside of the redesigned tray.
Conclusion
The comparison of anesthesia tray designs produced by an information processing approach and an ecological approach provide an interesting point of view in which to assess the similarities and differences of each approach. Similarities that were identified by both approaches are likely the result of common ground in the problem being solved and should be taken as fundamental recommendations to include when adjusting the layout of anesthesia trays. Additional tray features that were identified by the ecological approach may improve performance of selecting medications from the anesthesia tray, but user-based testing is needed to verify this claim.
In sum, the ecological approach offers a slightly different frame than a traditional information processing approach and can identify new and different points of leverage to influence the design of physical tools, such as anesthesiology trays.
References
Shultz J Davies JM Caird J Chisholm S Ruggles K Puls R. Standardizing anesthesia medication drawers using human factors and quality assurance methods. Can J Anesth2010; 57: 490–9
Wahr, J. A., Abernathy III, J. H., Lazarra, E. H., Keebler, J. R., Wall, M. H., Lynch, I., ... & Cooper, R. L. (2017). Medication safety in the operating room: literature and expert-based recommendations. BJA: British Journal of Anaesthesia, 118(1), 32-43.
Gibson, J. J. (2014). The ecological approach to visual perception: classic edition. Psychology press.
Methods
Information processing approach:
To correct limitations in perception, mental models, attention and memory, Shultz et al. (2010) reference design guidelines from human factors literature to construct and standardized the anesthesia tray. They also implemented a photographic survey to visualize the anesthesia carts used in the healthcare system, a questionnaire to add or remove medications to include in the anesthesia tray, and a “jigsaw” method where anesthesiologists arranged photos of different medication compartments to where they felt was most relevant for anesthesia work. Afterwards they constructed a mock anesthesia tray to elicit feedback from anesthesiologists about the arrangement of medications in the tray.
Ecological approach:
From an ecological perspective, the principle of information being nested in superordinate and subordinate units within an environment and acknowledgement that the invariant structure produced by the relationship between units helps to guide perception and action, was evoked to create a prototype anesthesia tray for Intermountain Health (Gibson, 1980).
Methods of our design process included 1) reviewing anesthesia charts to assess the order in which medications are administered in perioperative settings, 2) interviews and conversations with anesthesiologists and pharmacists to elicit their feedback about the design of the tray and iteration of the design based on their feedback, and 3) user testing of the newly designed tray as compared to the current tray (pending).
Results
Table 1 provides the comparison of anesthesia trays produced from an information processing approach – adopted by Shultz et al. (2010) – and an ecological approach. Specifically, Table 1 outlines the resulting tray features included in one or both tray designs and – where applicable – a brief description of the differences in how each tray feature was executed in the final tray design according to the information processing approach and ecological approach. (Due to limitations of the submission site that did not allow for the table to be displayed in the correct format, we have opted for a brief example of the contents of the table in plain text format below. "|" indicates separation of columns).
Table 1
Tray Feature | Information processing | Ecological approach
Group medications by function | NA | NA
Isolate potent medications | Positioned “dangerous” medications in back of tray | High potency and “other” medications placed in back of tray
Color-coding and use of patterns | Checkerboard pattern added to distinguish dangerous medications | Color and patterns added to compartment backgrounds to assist with discriminability between medication groups
Gradation of color and patterns | Not available | Color and pattern gradation added to assist with distinguishing potency of medications within groups
Alignment with workspace outside of anesthesia tray | Not available | Relocation of controlled substances tray to align with the new anesthesia tray design
Discussion
Results suggest there are some similarities, but numerous differences in the anesthesia trays designed from an information processing approach and an ecological approach. Tray features that were implemented in the same fashion between the two trays demonstrate the common ground shared by these projects – both were attempting to design a tray that will improve anesthesiologists’ ability to quickly and accurately select medications.
Though a combination of factors are likely at play to determine the execution or inclusion of any/all of the design features listed in Table 1, some can more readily be explained by a difference in the approach that is taken. For instance, Shultz et al. (2010) avoidance of using colored tray compartment backgrounds in an effort to draw more attention to the labels of each vial of medication could be viewed as a function of an information processing approach that increases salience of important information by reducing the visual unification of medication groups. From an ecological approach, including color and patterns in compartment backgrounds not only unifies medications as a group, but creates an affordance that can assist anesthesiologists’ ability to discriminate medication groupings, recognize the potency of medications within groups, and provide structure to help guide their attention while using the tray.
Another difference offered by the ecological approach that was potentially out-of-scope of the information processing lens, was the recognition that the medication tray works in concert with other components that compose the “whole” anesthesiologist work environment. In the present project, this recognition resulted in relocating the controlled substances bin – which is separate than the redesigned tray – to the left-side of the redesigned anesthesia tray because they serve the same function as induction agents. In essence, the ecological approach allowed for expansion of the logic of the tray (i.e., grouping and medications being positioned in order of chronologic use) to aspects of the anesthesiologist’ work environment that are outside of the redesigned tray.
Conclusion
The comparison of anesthesia tray designs produced by an information processing approach and an ecological approach provide an interesting point of view in which to assess the similarities and differences of each approach. Similarities that were identified by both approaches are likely the result of common ground in the problem being solved and should be taken as fundamental recommendations to include when adjusting the layout of anesthesia trays. Additional tray features that were identified by the ecological approach may improve performance of selecting medications from the anesthesia tray, but user-based testing is needed to verify this claim.
In sum, the ecological approach offers a slightly different frame than a traditional information processing approach and can identify new and different points of leverage to influence the design of physical tools, such as anesthesiology trays.
References
Shultz J Davies JM Caird J Chisholm S Ruggles K Puls R. Standardizing anesthesia medication drawers using human factors and quality assurance methods. Can J Anesth2010; 57: 490–9
Wahr, J. A., Abernathy III, J. H., Lazarra, E. H., Keebler, J. R., Wall, M. H., Lynch, I., ... & Cooper, R. L. (2017). Medication safety in the operating room: literature and expert-based recommendations. BJA: British Journal of Anaesthesia, 118(1), 32-43.
Gibson, J. J. (2014). The ecological approach to visual perception: classic edition. Psychology press.
Event Type
Poster Presentation
TimeTuesday, March 264:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives