Timing and collaboration in the Neonatal Intensive Care Unit
Timing, Collaboration, Neonatal Intensive Care, Cognitive Task Analysis
This study investigated how timing and collaboration issues in human-machine interaction (HMI) affect dependability in neonatal intensive care. An expert system, FLORENCE (Fuzzy LOgic for REspiratory Neonatal Care Expert), is being developed at St James’s University Hospital (Leeds) to help senior house officers (junior doctors) make decisions about changes to the ventilators that are regularly used in treating premature babies. A case study of the current socio-technical system that implements the practice of neonatal intensive care at SJUH identified several timing and collaboration issues related to the dependability of the system. These issues were used to generate requirements for the design and use of FLORENCE that should help to ensure that the dependability of the new system (including FLORENCE) should be at least equal to the dependability of the system without FLORENCE.
A Cognitive Task Analysis of the NICU uncovered examples of the following timing issues:
• Sequences, e.g. check baby’s airways,
breathing then circulation (ABC);
The implications of these findings can be summarised
in two key aspects that should help to ensure that FLORENCE does not make
the system of neonatal intensive care less dependable. The first lies
in the education of the front line carers. During the SHOs induction training,
the role and purpose of FLORENCE needs to be very clearly explained so
that they know how FLORENCE integrates with the other aspects of their
work. The second is the monitoring of the use of FLORENCE. As part of
the checking of the progress of the SHOs, senior staff will need to monitor
the usage of FLORENCE to make sure that front line carers do not become
too trusting or over-reliant on FLORENCE. This will necessarily include
checking how much SHOs are learning from communicating and collaborating
with other staff. The process of monitoring the use of FLORENCE will therefore
need to be an ongoing one.
Baxter, G.D., Filipe, J-K., Miguel, A. & Tan, K. (2005). The effects of timing and collaboration on dependability in the neonatal intensive care unit. In. F.Redmill & T. Anderson (Eds.), Constituents of modern system-safety thinking: Proceedings of the thirteenth safety-critical systems symposium (pp. 195-210). Berlin, Germany: Springer Verlag.
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