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The role of human factors in the fight against sepsis

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the human factors approach can trasform the sepsis challenges into opportunities for improving the health care system

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The role of human factors in the fight against sepsis

  1. 1. #wsc16#wsc16 The Role of Human Factors in Fighting Against Sepsis Giulio Toccafondi Patient Safety and Quality Manager Centro Gestione Rischio Clinico Regione Toscana - Tuscany http://www.regione.toscana.it/rischioclinico/ toccafondig@aou-careggi.toscana.it
  2. 2. #wsc16 • We have to convert sepsis into an opportunitiy for improving healthcare • The factors that enable an effective response to sepsis are the same that make the healthcare system resilient and safe Transform Criticalities Into Opportunities
  3. 3. #wsc16 The Challenges of Sepsis… 1. Difficult to diagnose - It can be confused with a constellation of other clinical signs and symptoms. The identification of sepsis requires expertise and training. 2. Difficult to locate - As far as we know, everyone can develop organ dysfunction in consequence of an infection. Therefore risk stratification is not straightforward as for other time-framed pathologies such as AMI and stroke. 3. Difficult to manage - If not timely recognized. Sepsis is time dependent patient mortality increases of 8% for every hour spent outside of a safe and validated clinical pathway.
  4. 4. #wsc16 …Are Complex Challeges… @gapinvoid …with complex responses: the impact of Sepsis can be reduced through a systemic and integrated approach focusing comprehensiveley on the overall organization:
  5. 5. #wsc16 …Are Complex Challeges… …with complex responses: the impact of sepsis can be reduced through a systemic and integrated approach focusing comprehensiveley on the overall organization: the network is more powerful than the node @gapinvoid
  6. 6. #wsc16 Human Factors Ergonomics (or Human Factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance
  7. 7. #wsc16 Human Factors: background
  8. 8. #wsc16 Human Factors: background When the technological advances outpaced the ability of people to adapt and compensate to poor designs human factors and ergonomics (HFE) became a fundamental asset in system designs, system evaluation and system redesign in many sectors and in healthcare as well we must fit the tasks to people’s needs, characteristics and motives and not fit the people to the task
  9. 9. #wsc16 Human Factors: in healthcare
  10. 10. #wsc16 Human Factors: in healthcare By acknowledging human limitations, Human Factors offers ways to minimise and mitigate human frailties, enhance human performance and reduce medical error and its consequences. The principles and practices of Human Factors focus on optimising human performance through better understanding the behaviour of individuals, their interactions with each other and with their environment. Human Factors underpin current patient safety and quality improvement science. It offers an integrated, evidenced and coherent approach to patient safety, quality improvement and clinical excellence Human Factors in Healthcare 2013 NHS www.england.nhs.uk
  11. 11. #wsc16 Sepsis challenges the way in which the moving parts of the care process interacts improve care coordination through the sepsis clinical pathway Sepsis challenges the ways boundaries are set between disciplines promote open organization and train professionals for situational awarness Sepis challenges the ways in which skills and services are distributed between healthcare sectors enable team work and communication accross different levels of care Challenges Become Opportunities 3 1 2
  12. 12. #wsc16 Sepsis Clinical Pathway - 1 Everyone can become septic. Sepsis and septic shock are a problem of all clinical specialities - Are healthcare organizations ready? HDU Operating Theatre IMAGING LABORATORYENDOSCOPY Surgical Department MEWS System Sepsis Septic Shock INTENSIVE CARE UNIT C R I T I C A L A R E AED TRIAGE Paediatric Dep MEWS System Patient Flow Community Care Medical Dep MEWS System Maternal Child Dep MEWS System Organization
  13. 13. #wsc16 1 -Patients Identification 2-Diagnosis and Framework 3 -Treatment Antibiotic therapy Cultural exams Imaging Haemodynamic monitoring Urinary output Oxygen therapy Fluid therapy Vasoactive and inotropic therapy Blood products Source control Identification Re-evaluation Pathway starting up Biochemical diagnosis (biomarkers) 1 Sepsis Clinical Pathway
  14. 14. #wsc16 Evaluation 1 -Patients Identification 2-Diagnosis and Framework 3 -Treatment Antibiotic therapy Cultural exams Imaging Haemodynamic monitoring Urinary output Oxygen therapy Fluid therapy Vasoactive and inotropic therapy Blood products Source control Identification Re-evaluation Pathway starting up Biochemical diagnosis (biomarkers) 1 + Sepsis Clinical Pathway
  15. 15. #wsc16 Human Factors to fight Against Sepsis • Definition of a National Clinical Pathway for managing Sepsis • National Clinical Risk Managers manifesto against sepsis based on the Sespis Declaration • Multidisciplianry e-learning courses endoresed by national scientific societies • Tackling Sepsis in different clinical context 1
  16. 16. #wsc16 Comprehension Projection Perception To Anticipate Future To Give Meaning To know, To monitor Action Decision Environment Feedback 2 Situational Awareness Everyone can identify sepsis. To diagnose and manage sepsis with a time dependent approach we need professionals able to think «out of the box» paying attention to weak signals coming form the enviroment (patient, equipment , team, caregivers , vital signs) Are the healthcare professionals ready? Individual
  17. 17. #wsc16 2 Situational Awareness Access to ED and recognition of sepsis in Medical Ward ( 51.5% of ICU sepsis came from the ward ) hold s difficulties due both to the characteristics of the patient and the situation in which professionals operate . It is necessary to strengthen the recognition of the critically ill patient through SIMULATION BASED TRAINING Individual Levy M, Lancet Infect Dis. 2012; 12(12):919-24
  18. 18. #wsc16 Teamwork and Communication – Eduardo Salas, Dana E. Sims and C. Shawn BurkeSmall Group Research 2005 36: 555 MUTUAL TRUST SHARED MENTAL MODELS CLOSED LOOP COMMUNICATION 1 –Mutual performance monitoring 2-Team leadership 4-Back up Behaviour 5-Adaptability 3 Everyone can manage sepsis - To manage sepsis we need adaptive team able to collaborate regardless of the disciplinary background or professiona l role (physician, nurse, microbiologist, manager, patient, gp) Are healtcare group real teams? 3-Team effectiveness 6- Team orientation Group
  19. 19. #wsc16 HFE Systemic Approach against Sepsis Individual Organization Group Activity Level • Sepis Liason person in Every Setting/Discipline • Sepsis group • Sepsis pathway • Organizational checklist • Training program – Simulation • Evaluation framework • Shared Mental Models Action Level • Learning and reporting • Peer-to-peer learning • Process overview • Job design (who does what when) • Sepsis pathway in context • Tailored training Sessions • Iterative auditing • Data analysis • Common vocabulary • Participatpry approach to (re)design of protocols • Team building and Trust • Support tools (MEWS, Q.Sofa) Operation Level • Skill training • Simulation based training • Sepsis bundle • Active listening • Situational awareness • Physcial Ergonomics (space, layout, interface, tools) • Data collection interface • Usability testing • Simulation based training • Communication Loop
  20. 20. #wsc16 National Ministery of Health – Safety of Care Committee Interest Group for Recommandation on compliance to 3 and 6 hours Sepsis Bundle Introducing Patient Safety Practice for fighting Sepsis and Septic Shock National Level International Level Standardized Education and Training module for: ED staff, Medical ward, Surgical area, Critical Care Area , Maternal Area Human Factors Proactive analysis of Sepsis pathway implementation Participation to the Global Sepsis Alliance Network ITALY TUSCANYRegional Level
  21. 21. #wsc16 Conclusion – Fighting against sepsis «in the wild» • Sepsis is a medical emergency and an organizational challenge • Human Factors have the potentials to enhance organizational capabilities for fighting Sepsis • Networking and collaborations across disciplines and systems is the success factor In order to fight Sepsis we have to change our organizations. In order to change our organization we have to change the way of working and consequently ourselves Embodied Knowledge
  22. 22. #wsc16#wsc16 Thanks for your attention Thanks to Riccardo Tartaglia and Giorgio Tulli Giulio Toccafondi Centro Gestione Rischio Clinico Regione Toscana - Tuscany http://www.regione.toscana.it/rischioclinico/ toccafondig@aou-careggi.toscana.it

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