Developing Unique Engineering Solutions to Improve Patient Safety
Many efforts to improve healthcare safety have focused on redesigning processes of care or retraining clinicians. Far less attention has been focused on the use of new technologies to improve safety. We present the results of a unique collaboration between the VA National Center for Patient Safety (NCPS) and the Thayer School of Engineering at Dartmouth College. Each year, the NCPS identifies safety problems across the VA that could be addressed with newly-engineered devices. Teams of Thayer students and faculty participating in a senior design course evaluate and engineer a solution for one of the problems. Exemplar projects have targeted surgical sponge retention, nosocomial infections, surgical site localization, and remote monitoring of hospitalized patients undergoing diagnostic testing and procedures. The program has served as an avenue for engineering students and health care workers to solve problems together. The success of this academic-clinical partnership could be replicated in other settings.
Institute of Medicine, To Err is Human: Building a Safer Healthcare System, National Academies Press, Washington, DC, 2000.
C. P. Landrigan, G. J. Parry, C. B. Bones, A. D. Hackbarth, D. A. Goldmann, and P. J. Sharek, “Temporal trends in rates of patient harm resulting from medical care,” New England Journal of Medicine, vol. 363, no. 22, pp. 2124–2134, 2010.View at: Google Scholar
J. P. Bagian, C. Lee, J. Gosbee et al., “Developing and deploying a patient safety program in a large health care delivery system: you can't fix what you don't know about,” Joint Commission Journal on Quality Improvement, vol. 27, no. 10, pp. 522–532, 2001.View at: Google Scholar
J. P. Bagian, “Health care and patient safety: The failure of traditional approaches — how human factors and ergonomics can and MUST help,” Human Factors and Ergonomics in Manufacturing and Service Industries, vol. 22, no. 1, pp. 1–6, 2012.View at: Google Scholar
J. Neily, P. D. Mills, Y. Young-Xu et al., “Association between implementation of a medical team training program and surgical mortality,” Journal of the American Medical Association, vol. 304, no. 15, pp. 1693–1700, 2010.View at: Google Scholar
B. V. Watts, K. Percarpio, P. West, and P. D. Mills, “Use of the Safety Attitudes Questionnaire as a measure in patient safety improvement,” Journal of Patient Safety, vol. 6, no. 4, pp. 206–209, 2010.View at: Google Scholar
D. A. Norman, The Design of Everyday Things, Basic Books, New York, 1988.
A. W. Wu, A. K. Lipshutz, and P. J. Pronovost, “Effectiveness and efficiency of root cause analysis in medicine,” Journal of the American Medical Association, vol. 299, no. 6, pp. 685–687, 2008.View at: Google Scholar
J. P. Bagian, J. Gosbee, C. Z. Lee, L. Williams, S. D. McKnight, and D. M. Mannos, “The Veterans Affairs root cause analysis system in action,” Joint Commission Journal on Quality Improvement, vol. 28, no. 10, pp. 531–545, 2002.View at: Google Scholar
J. DeRosier, E. Stalhandske, J. P. Bagian, and T. Nudell, “Using health care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system,” Joint Commission Journal on Quality Improvement, vol. 28, no. 5, pp. 248–267, 209, 2002.View at: Google Scholar
B. V. Watts, Y. Young-Xu, P. D. Mills et al., “An Examination of the Effectiveness of a Mental Health Environment of Care Checklist in Reducing Suicide on Inpatient Mental Health Units,” Archives of General Psychiatry, vol. 69, no. 6, pp. 588–929, 2012, Jun 1.View at: Google Scholar
E. Frye, Engineering problem solving for mathematics, science, and technology education, Trustees of Dartmouth College, Hanover, NH, 1996.
S. E. Regenbogen, C. C. Greenberg, S. C. Resch et al., “Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness,” Surgery, vol. 145, no. 5, pp. 527–535, 2009.View at: Google Scholar
V. C. Gibbs and A. D. Auerbauch, “The Retained Surgical Sponge,” in Making Healthcare Safer: A Critical Analysis of Patient Safety Practices, K. G. Edited by Shojania, B. W. Duncan, K. M. McDonald, and R. M. Wachter, Eds., Agency for Healthcare Quality and Research, Rockville, MD, 2001.View at: Google Scholar
R. R. Cima, A. Kollengode, J. Clark et al., “Using a data-matrix-coded sponge counting system across a surgical practice: impact after 18 months,” Joint Commission Journal on Quality and Patient Safety, vol. 37, no. 2, pp. 51–58, 2011.View at: Google Scholar
S. L. Ting and A. H. C. Tsang, “Development of an RFID-based Surgery Management System: Lesson Learnt from a Hong Kong Public Hospital,” Journal of Healthcare Engineering, vol. 3, no. 3, 2012.View at: Google Scholar
C. C. Greenberg, “Gawande Retained foreign bodies,” Advances in Surgery, vol. 42, pp. 183–191, 2008.View at: Google Scholar
Collegiate Inventors Competition, http://www.invent.org/collegiate/overview.html.
K. M. Arias, Outbreak Investigation, Prevention, and Control in Health Care Settings: Critical Issues in Patient Safety, Jones and Bartlett Publishers, Sudbury, MA, 2010.
N. E. Eldridge, S. S. Woods, R. S. Bonello et al., “Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units,” Journal of General Internal Medicine, vol. 21 Suppl 2, pp. S35–42, 2006.View at: Google Scholar
A. Lipitz-Snyderman, D. M. Needham, E. Colantuoni et al., “The ability of intensive care units to maintain zero central line-associated bloodstream infections,” Archives of Internal Medicine, vol. 171, no. 9, pp. 856–858, 2011.View at: Google Scholar
J. Neily, P. D. Mills, N. Eldridge et al., “Incorrect surgical procedures within and outside of the operating room: a follow-up report,” Archives of Surgery, vol. 146, no. 11, pp. 1235–1239, 2011.View at: Google Scholar
J. Neily, P. D. Mills, N. Eldridge et al., “Incorrect surgical procedures within and outside of the operating room,” Archives of Surgery, vol. 144, no. 11, pp. 1028–1034, 2009.View at: Google Scholar
J. Devine, N. Chutkan, D. C. Norvell, and J. R. Dettori, “Avoiding wrong site surgery: a systematic review,” Spine (Philadelphia PA, 1976), vol. 35, no. 9 Suppl, pp. S28–36, 2010.View at: Google Scholar
M. G. Mody, A. Nourbakhsh, D. L. Stahl, M. Gibbs, M. Alfawareh, and K. J. Garges, “The prevalence of wrong level surgery among spine surgeons,” Spine (Philadelphia PA, 1976), vol. 33, no. 2, pp. 194–198, 2008.View at: Google Scholar
K. Arfanis, E. Fioratou, and A. Smith, “Safety culture in anesthesiology: Basic concepts and practical application,” Best Practice and Research Clinical Anesthesiology, vol. 25, pp. 229–38, 2011.View at: Google Scholar
M. J. Highsmith, J. T. Kahle, D. R. Bongiorni, B. S. Sutton, S. Groer, and K. R. Kaufman, “Safety, energy efficiency, and cost efficacy of the C-Leg for transfemoral amputees: A review of the literature,” Prosthetics and Orthotics International, vol. 34, no. 4, pp. 362–377, 2010.View at: Google Scholar
H. Mohammadi and K. Mequanint, “Prosthetic aortic heart valves: modeling and design,” Medical Engineering & Physics, vol. 33, no. 2, pp. 131–147, 2011.View at: Google Scholar
A. Wennerberg and T. Albrektsson, “Current challenges in successful rehabilitation with oral implants,” Journal of Oral Rehabilitation, vol. 38, no. 4, pp. 286–294, 2011.View at: Google Scholar