Medico-legal barriers to practising Realistic Medicine have been identified as fear of criticism from complaints, and concerns about other forms of criticism such as external inspection, clinical reviews and litigation. “The Montgomery ruling states that healthcare professionals must make patients aware of risk, benefits and alternatives that a reasonable patient would think were material and that a reasonable doctor would be aware are relevant to that particular patient.” [The Scottish Government. Practising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2016-17. Published 2018. https://www.gov.scot/publications/practising-realistic-medicine/]
Personalised care can help manage the risk better by having more open conversations and more meaningful dialogue with patients that leads to less criticism and fewer complaints. At a system level, human factors and ergonomics (HFE) is about “understanding and improving the ‘fit’ between people and their working environment to ensure a safer, more productive and efficient workplace”. HFE has been embedded in other safety-critical industries such as energy and transport. NHS Scotland has been involved in work related to HFE areas of interest such as the SPSP (Scottish Patient Safety Programme) but more work needs to be done to incorporate HFE thinking and procedure into everyday practice. [The Scottish Government. Personalising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2017-18. Published 2019. https://www.gov.scot/publications/personalising-realistic-medicine-chief-medical-officer-scotland-annual-report-2017-2018/pages/7/]
Healthcare Improvement Scotland. Scottish Patient Safety Programme http://www.healthcareimprovementscotland.org/our_work/patient_safety/spsp.aspx (accessed 08/10/2019)
SCHUBEL, L., et al, 2019. Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis. Health Informatics Journal, 1460458219839623
In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are a wide range of sepsis alerts in clinical care that act as clinical decision support tools to assist in early recognition of sepsis; however, there are serious shortcomings in existing health information technology for alerting providers in a meaningful way. Little work has been done to evaluate and assess existing alerts using implementation and process outcomes associated with health information technology displays, specifically evaluating clinician preference and performance. We developed graphical model displays of two popular sepsis scoring systems, quick Sepsis Related Organ Failure Assessment and Predisposition, Infection, Response, Organ Failure, using human factors principles grounded in user-centered and interaction design. Models will be evaluated in a larger research effort to optimize alert design to improve the collective awareness of high-risk populations and develop a relevant point-of-care clinical decision support system for sepsis.
XIE, A., et al, 2019. Use of Human Factors and Ergonomics to Disseminate Health Care Quality Improvement Programs. Quality management in health care, 28(2), pp. 117-118.