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Dr. Yuval Bitan
Ben-Gurion University of the Negev

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0 Alarm Systems
0 Human Factors Engineering
0 Patient Safety
0 System Analysis
0 Decision Making under Uncertainty

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Patient Safety
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Decision Making under Uncertainty

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Journal article
Published: 16 August 2021 in Computer Methods and Programs in Biomedicine
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Poor clinical data quality might affect clinical decision making and patient treatment. This study identifies quality defects in clinical data collected automatically by bedside monitoring devices in the Intensive Care Unit (ICU) and examines their effect on clinical decisions. Real-world data collected from 7688 patients admitted to the general ICU in a tertiary referral hospital over seven years was retrospectively analyzed. Data quality defect detection methods that use time-series analysis techniques identified two types of data quality defects: (a) completeness: the extent of non-missing values, and (b) validity: the extent of non-extreme values within the continuous range of values. Data quality defects were compared to five scenarios of medication and procedure prescriptions that are common in ICU settings: Blood-pressure reduction, blood-pressure elevation, anesthesia medications, intubation procedures, and muscle relaxant medications. Results from a logistic regression revealed a strong connection between data quality and the clinical interventions examined: lower validity level increased the likelihood of prescription decisions for all five scenarios, and lower completeness level increased the likelihood of prescription decisions for some scenarios. The results highlight the possible effect of data quality defects on physicians' decisions. Lower validity of certain key clinical parameters, and in some scenarios lower completeness, correlated with stronger tendency to prescribe medications or perform invasive procedures. Data quality defects in clinical data affect decision making even without practitioners’ awareness. Thus, it is important to emphasize these effects to ICU staff, as well as to medical device manufacturers.

ACS Style

Oren Kramer; Adir Even; Idit Matot; Yohai Steinberg; Yuval Bitan. The impact of data quality defects on clinical decision-making in the intensive care unit. Computer Methods and Programs in Biomedicine 2021, 209, 106359 .

AMA Style

Oren Kramer, Adir Even, Idit Matot, Yohai Steinberg, Yuval Bitan. The impact of data quality defects on clinical decision-making in the intensive care unit. Computer Methods and Programs in Biomedicine. 2021; 209 ():106359.

Chicago/Turabian Style

Oren Kramer; Adir Even; Idit Matot; Yohai Steinberg; Yuval Bitan. 2021. "The impact of data quality defects on clinical decision-making in the intensive care unit." Computer Methods and Programs in Biomedicine 209, no. : 106359.

Research article
Published: 18 July 2021 in Human Factors: The Journal of the Human Factors and Ergonomics Society
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Objective To develop a new model to quantify information management dynamically and to identify factors that lead to information gaps. Background Information management is a core task for emergency medical service (EMS) team leaders during the prehospital phase of a mass-casualty incident (MCI). Lessons learned from past MCIs indicate that poor information management can lead to increased mortality. Various instruments are used to evaluate information management during MCI training simulations, but the challenge of measuring and improving team leaders’ abilities to manage information remains. Method The Dynamic Communication Quantification (DCQ) model was developed based on the knowledge representation typology. Using multi point-of-view synchronized video, the model quantifies and visualizes information management. It was applied to six MCI simulations between 2014 and 2019, to identify factors that led to information gaps, and compared with other evaluation methods. Results Out of the three methods applied, only the DCQ model revealed two factors that led to information gaps: first, consolidation of numerous casualties from different areas, and second, tracking of casualty arrivals to the medical treatment area and departures from the MCI site. Conclusion The DCQ model allows information management to be objectively quantified. Thus, it reveals a new layer of knowledge, presenting information gaps during an MCI. Because the model is applicable to all MCI team leaders, it can make MCI simulations more effective. Application This DCQ model quantifies information management dynamically during MCI training simulations.

ACS Style

Omer Perry; Eli Jaffe; Yuval Bitan. Dynamic Communication Quantification Model for Measuring Information Management During Mass-Casualty Incident Simulations. Human Factors: The Journal of the Human Factors and Ergonomics Society 2021, 1 .

AMA Style

Omer Perry, Eli Jaffe, Yuval Bitan. Dynamic Communication Quantification Model for Measuring Information Management During Mass-Casualty Incident Simulations. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2021; ():1.

Chicago/Turabian Style

Omer Perry; Eli Jaffe; Yuval Bitan. 2021. "Dynamic Communication Quantification Model for Measuring Information Management During Mass-Casualty Incident Simulations." Human Factors: The Journal of the Human Factors and Ergonomics Society , no. : 1.

Journal article
Published: 22 January 2021 in Applied Sciences
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The overall goal of the novel Functionality, Usability, Look-and-Feel, and Evaluation (FULE) user-centered methodology for product design proposed in this paper is to develop usable and aesthetic products. Comprising several product design methods, this novel methodology we devised focuses on the product designer’s role and responsibility. Following the first three formative assessment phases that define the product’s functionality, usability, and look-and-feel, the summative evaluation phase not only assesses the product, but also provide guidelines to its implementation, marketing, and support. A case study devoted to the design of an autonomous medical device illustrates how the FULE methodology can provide the designer with tools to better select among design alternatives and contribute to reducing bias and subjective decisions.

ACS Style

Ela Liberman-Pincu; Yuval Bitan. FULE—Functionality, Usability, Look-and-Feel and Evaluation Novel User-Centered Product Design Methodology—Illustrated in the Case of an Autonomous Medical Device. Applied Sciences 2021, 11, 985 .

AMA Style

Ela Liberman-Pincu, Yuval Bitan. FULE—Functionality, Usability, Look-and-Feel and Evaluation Novel User-Centered Product Design Methodology—Illustrated in the Case of an Autonomous Medical Device. Applied Sciences. 2021; 11 (3):985.

Chicago/Turabian Style

Ela Liberman-Pincu; Yuval Bitan. 2021. "FULE—Functionality, Usability, Look-and-Feel and Evaluation Novel User-Centered Product Design Methodology—Illustrated in the Case of an Autonomous Medical Device." Applied Sciences 11, no. 3: 985.

Research article
Published: 05 August 2020 in Ergonomics in Design: The Quarterly of Human Factors Applications
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Emergency response to a pandemic requires health care systems to initiate many activities. One of these activities is providing the public with information and guidance about the symptoms and the actions that need to be taken. A dedicated call center should facilitate the public need. Such a call center needs to be carefully designed to protect the call takers from potentially being infected by other staff members. An ad hoc facility has the flexibility to adjust to evolving demands and constraints. This article presents the need, the concerns, and the guidelines used to design such call center during the COVID-19 pandemic outbreak.

ACS Style

Yuval Bitan; Itamar Abramovich; Eli Jaffe. Designing a First Responders Call Center for a Pandemic. Ergonomics in Design: The Quarterly of Human Factors Applications 2020, 29, 25 -28.

AMA Style

Yuval Bitan, Itamar Abramovich, Eli Jaffe. Designing a First Responders Call Center for a Pandemic. Ergonomics in Design: The Quarterly of Human Factors Applications. 2020; 29 (1):25-28.

Chicago/Turabian Style

Yuval Bitan; Itamar Abramovich; Eli Jaffe. 2020. "Designing a First Responders Call Center for a Pandemic." Ergonomics in Design: The Quarterly of Human Factors Applications 29, no. 1: 25-28.

Journal article
Published: 20 March 2020 in Technology and Health Care
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Video communications during cardiopulmonary resuscitation (CPR) can improve the quality of information exchange between a bystander performing CPR and an emergency medical dispatcher (EMD). To improve chest compression effectiveness, a filming protocol instructing video camera placements around a patient was developed. This study measured whether the filming protocol increased chest compressions' effectiveness. A simulation study was conducted comparing CPR effectiveness under three conditions: telephone-instructed, video-instructed, and video-instructed with the filming protocol. Twenty-five emergency medical technicians acted as EMDsin the three conditions. A mannequin measured five factors that determined the effectiveness of the chest compressions. Compared with telephone-instructed CPR, the filming protocol improved the proportion of time in which the bystander's hands were in the correct position during chest compressions. Compared with video-instructed CPR, the filming protocol improved both the proportion of time in which the chest was fully released after each compression and the proportion of time in which the compressions were conducted with an appropriate rhythm. The depth and rate of compressions did not improve in the filming protocol condition. Video-instructed CPR with the filming protocol improves CPR effectiveness compared to telephone- and video-instructed CPR. Detailed implementation can improve new technology introduction.

ACS Style

Omer Perry; Oren Wacht; Eli Jaffe; Zilla Sinuany-Stern; Yuval Bitan. Using a filming protocol to improve video-instructed cardiopulmonary resuscitation. Technology and Health Care 2020, 28, 213 -220.

AMA Style

Omer Perry, Oren Wacht, Eli Jaffe, Zilla Sinuany-Stern, Yuval Bitan. Using a filming protocol to improve video-instructed cardiopulmonary resuscitation. Technology and Health Care. 2020; 28 (2):213-220.

Chicago/Turabian Style

Omer Perry; Oren Wacht; Eli Jaffe; Zilla Sinuany-Stern; Yuval Bitan. 2020. "Using a filming protocol to improve video-instructed cardiopulmonary resuscitation." Technology and Health Care 28, no. 2: 213-220.

Journal article
Published: 08 November 2019 in Ergonomics in Design: The Quarterly of Human Factors Applications
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Fast, effective, and accurate emergency medical treatment can save lives. Quick access to the specific equipment that emergency medical personnel need facilitates more efficacious treatment during emergencies. This project focuses on designing an improved emergency response kit for medical first responders. The kit currently in use has no organizational standard for the way the medical items it contains are placed inside. With a user-centered method, we designed a kit that better fits first responders’ requirements and found that the kit – a backpack and a vest – is both easier to use and carry, based on emergency care priorities.

ACS Style

Yuval Bitan; Amit Shreiber; Gili Zafon; Eli Jaffe. Designing a First Responders’ Emergency Response Kit for Motor-Vehicle Collisions. Ergonomics in Design: The Quarterly of Human Factors Applications 2019, 28, 1 .

AMA Style

Yuval Bitan, Amit Shreiber, Gili Zafon, Eli Jaffe. Designing a First Responders’ Emergency Response Kit for Motor-Vehicle Collisions. Ergonomics in Design: The Quarterly of Human Factors Applications. 2019; 28 (4):1.

Chicago/Turabian Style

Yuval Bitan; Amit Shreiber; Gili Zafon; Eli Jaffe. 2019. "Designing a First Responders’ Emergency Response Kit for Motor-Vehicle Collisions." Ergonomics in Design: The Quarterly of Human Factors Applications 28, no. 4: 1.

Journal article
Published: 25 October 2019 in Applied Ergonomics
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This study investigates how the positions of paramedic equipment bags affect paramedic performance and biomechanical loads during out-of-hospital Cardiopulmonary Resuscitation (CPR). An experiment was conducted in which 12 paramedic teams (each including two paramedics) performed in-situ simulations of a cardiac-arrest scenario. CPR quality was evaluated using five standard resuscitation measures (i.e., pre- and post-shock pauses, and compression rate, depth and fraction). The spinal loads while lifting, pulling and pushing the equipment bags were assessed using digital human modeling software (Jack) and prediction equation from previous studies. The results highlight where paramedics are currently choosing to position their equipment. They also demonstrate that the positions of the equipment bags affect CPR quality as well as the paramedics' work efficiency, physiological effort and biomechanical loads. The spinal loads ranged from 1901 to 4030N; furthermore, every occasion on which an equipment bag was lifted resulted in spinal forces higher than 3400N, thus exceeding the maximum threshold stipulated by the National Institute for Occupational Safety and Health. 72% of paramedics' postures were categorized as high or very high risk for musculoskeletal disorders by the Rapid Entire Body Assessment. Guidelines related to bag positioning and equipment handling might improve CPR quality and patient outcomes, and reduce paramedics’ risk of injury.

ACS Style

Yaar Harari; Raziel Riemer; Eli Jaffe; Oren Wacht; Yuval Bitan. Paramedic equipment bags: How their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance. Applied Ergonomics 2019, 82, 102977 .

AMA Style

Yaar Harari, Raziel Riemer, Eli Jaffe, Oren Wacht, Yuval Bitan. Paramedic equipment bags: How their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance. Applied Ergonomics. 2019; 82 ():102977.

Chicago/Turabian Style

Yaar Harari; Raziel Riemer; Eli Jaffe; Oren Wacht; Yuval Bitan. 2019. "Paramedic equipment bags: How their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance." Applied Ergonomics 82, no. : 102977.

Journal article
Published: 12 September 2019 in Australasian Journal of Paramedicine
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BackgroundEarly identification of out-of-hospital cardiac arrest (OHCA) has been proven to increase survival rates. Toward this goal, emergency medical dispatchers commonly use one of two types of emergency medical dispatcher systems, each with a unique OHCA protocol. The criteria-based dispatch (CBD) protocol is a set of guidelines and prompts intended for dispatchers with clinical background and experience, while the medical priority dispatch (MPD) is a scripted caller interrogation protocol intended for non-healthcare dispatchers. The objective of this study was to compare CBD and MPD protocols in terms of accuracy and duration of the identification process.MethodsTo compare the two protocols we conducted an OHCA simulation of an emergency phone call by a bystander. Two groups participated in the simulation: 1) emergency medical technicians during paramedic vocational training, in the role of CBD dispatchers, and 2) non-healthcare personnel in the role of MPD dispatchers. Dispatchers were asked to identify whether a patient was having a cardiac arrest based on the information they received from the bystander.ResultsDuration of the OHCA identification process was significantly shorter for participants using MPD (CBD 50 seconds vs. MPD 33 seconds, p=0.003). The OHCA accuracy was 86.49% for the CBD and 82.86% for MPD, but this difference was not statistically significant (p=0.60).ConclusionThe advantages of each protocol suggest that some combination of the two protocols may optimise the OHCA identification process, leading to increased accuracy and shorter duration of the identification process.

ACS Style

Omer Perry; Oren Wacht; Eli Jaffe; Zilla Sinuany-Stern; Yuval Bitan. Out-of-hospital cardiac arrest protocol comparison. Australasian Journal of Paramedicine 2019, 16, 1 .

AMA Style

Omer Perry, Oren Wacht, Eli Jaffe, Zilla Sinuany-Stern, Yuval Bitan. Out-of-hospital cardiac arrest protocol comparison. Australasian Journal of Paramedicine. 2019; 16 ():1.

Chicago/Turabian Style

Omer Perry; Oren Wacht; Eli Jaffe; Zilla Sinuany-Stern; Yuval Bitan. 2019. "Out-of-hospital cardiac arrest protocol comparison." Australasian Journal of Paramedicine 16, no. : 1.

Evaluation study
Published: 03 July 2019 in Applied Ergonomics
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A two phase project is described for redesigning and evaluating paramedic response bags, one of the key pieces of equipment used by emergency medical services. Adopting a user-centred approach, Phase I involved first educating active service paramedics about ergonomic principles, and then collaborating with them to conceptualise a new type of response bag, based on separate colour coded kits, each containing related equipment items. Phase II describes a formal evaluation study, involving simulated procedures with a patient mannequin and active service paramedics in a real ambulance. Results indicated subjective preferences for the new bags, where 62% of the paramedics believed it was easier to find equipment in the new bag and 65% preferred the new bags overall. No detrimental effects were attributed to the transition to the new bag. Also discussed are the advantages of the participatory design approach, as well as design guidelines and implications for paramedic operations.

ACS Style

Yuval Bitan; Scott Ramey; Paul Milgram. Ergonomic design of new paramedic response bags. Applied Ergonomics 2019, 81, 102890 .

AMA Style

Yuval Bitan, Scott Ramey, Paul Milgram. Ergonomic design of new paramedic response bags. Applied Ergonomics. 2019; 81 ():102890.

Chicago/Turabian Style

Yuval Bitan; Scott Ramey; Paul Milgram. 2019. "Ergonomic design of new paramedic response bags." Applied Ergonomics 81, no. : 102890.

Original research
Published: 06 April 2019 in Journal of Clinical Monitoring and Computing
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Studies reveal that the false alarm rate (FAR) demonstrated by intensive care unit (ICU) vital signs monitors ranges from 0.72 to 0.99. We applied machine learning (ML) to ICU multi-sensor information to imitate a medical specialist in diagnosing patient condition. We hypothesized that applying this data-driven approach to medical monitors will help reduce the FAR even when data from sensors are missing. An expert-based rules algorithm identified and tagged in our dataset seven clinical alarm scenarios. We compared a random forest (RF) ML model trained using the tagged data, where parameters (e.g., heart rate or blood pressure) were (deliberately) removed, in detecting ICU signals with the full expert-based rules (FER), our ground truth, and partial expert-based rules (PER), missing these parameters. When all alarm scenarios were examined, RF and FER were almost identical. However, in the absence of one to three parameters, RF maintained its values of the Youden index (0.94-0.97) and positive predictive value (PPV) (0.98-0.99), whereas PER lost its value (0.54-0.8 and 0.76-0.88, respectively). While the FAR for PER with missing parameters was 0.17-0.39, it was only 0.01-0.02 for RF. When scenarios were examined separately, RF showed clear superiority in almost all combinations of scenarios and numbers of missing parameters. When sensor data are missing, specialist performance worsens with the number of missing parameters, whereas the RF model attains high accuracy and low FAR due to its ability to fuse information from available sensors, compensating for missing parameters.

ACS Style

Gal Hever; Liel Cohen; Michael F. O’Connor; Idit Matot; Boaz Lerner; Yuval Bitan. Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU. Journal of Clinical Monitoring and Computing 2019, 34, 339 -352.

AMA Style

Gal Hever, Liel Cohen, Michael F. O’Connor, Idit Matot, Boaz Lerner, Yuval Bitan. Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU. Journal of Clinical Monitoring and Computing. 2019; 34 (2):339-352.

Chicago/Turabian Style

Gal Hever; Liel Cohen; Michael F. O’Connor; Idit Matot; Boaz Lerner; Yuval Bitan. 2019. "Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU." Journal of Clinical Monitoring and Computing 34, no. 2: 339-352.

Research article
Published: 26 March 2019 in Human Factors: The Journal of the Human Factors and Ergonomics Society
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Objective: To explore cognitive strategies clinicians apply while performing a medication reconciliation task, handling incomplete and conflicting information. Background: Medication reconciliation is a method clinicians apply to find and resolve inconsistencies in patients’ medications and medical conditions lists. The cognitive strategies clinicians use during reconciliation are unclear. Controlled lab experiments can explore how clinicians make sense of uncertain, missing, or conflicting information and therefore support the development of a human performance model. We hypothesize that clinicians apply varied cognitive strategies to handle this task and that profession and experience affect these strategies. Method: 130 clinicians participated in a tablet-based experiment conducted in a large American teaching hospital. They were asked to simulate medication reconciliation using a card sorting task (CaST) to organize medication and medical condition lists of a specific clinical case. Later on, they were presented with new information and were asked to add it to their arrangements. We quantitatively and qualitatively analyzed the ways clinicians arranged patient information. Results: Four distinct cognitive strategies were identified (“Conditions first”: n = 76 clinicians, “Medications first”: n = 7, “Crossover”: n = 17, and “Alternating”: n = 10). The strategy clinicians applied was affected by their experience ( p = .02) but not by their profession. At the appearance of new information, clinicians moved medication cards more frequently (75.2 movements vs. 49.6 movements, p < .001), suggesting that they match medications to medical conditions. Conclusion: Clinicians apply various cognitive strategies while reconciling medications and medical conditions. Application: Clinical information systems should support multiple cognitive strategies, allowing flexibility in organizing information.

ACS Style

Yuval Bitan; Yisrael Parmet; Geva Greenfield; Shelly Teng; Richard I. Cook; Mark E. Nunnally. Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task. Human Factors: The Journal of the Human Factors and Ergonomics Society 2019, 61, 1315 -1325.

AMA Style

Yuval Bitan, Yisrael Parmet, Geva Greenfield, Shelly Teng, Richard I. Cook, Mark E. Nunnally. Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2019; 61 (8):1315-1325.

Chicago/Turabian Style

Yuval Bitan; Yisrael Parmet; Geva Greenfield; Shelly Teng; Richard I. Cook; Mark E. Nunnally. 2019. "Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task." Human Factors: The Journal of the Human Factors and Ergonomics Society 61, no. 8: 1315-1325.

Article
Published: 01 March 2019 in Journal of Patient Safety
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Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts. The study data sets included infusion logs and drug libraries from three hospitals of one health system from January 2015 to December 2016. We identified limit setting changes of any two consecutive drug library versions. We quantified the impact of using outdated drug limit settings by missed and false infusion programming alerts. Twenty-five updates of the drug library were released within the health system during the 2-year period with an average interval of 28.8 days. After a new library version was issued, it took at least 6 days for 50% of all pumps to become up-to-date and 15 days or more to reach 80%. All three hospitals had at least 16% of all IV infusions programmed with outdated libraries. This resulted in 18%, 24.4%, and 27% of false alerts in the three hospitals, respectively. We identified two cases of missed alert infusions of high-risk medications, propofol, and potassium chloride, which could have negatively impacted patient safety. These findings support our assumption that potential serious harm can happen when IV infusions are administered with outdated drug limit settings due to delays in drug library updates on the pump.

ACS Style

Kang-Yu Hsu; Poching DeLaurentis; Yuval Bitan; Daniel D. Degnan; Yuehwern Yih. Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays. Journal of Patient Safety 2019, 15, e8 -e14.

AMA Style

Kang-Yu Hsu, Poching DeLaurentis, Yuval Bitan, Daniel D. Degnan, Yuehwern Yih. Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays. Journal of Patient Safety. 2019; 15 (1):e8-e14.

Chicago/Turabian Style

Kang-Yu Hsu; Poching DeLaurentis; Yuval Bitan; Daniel D. Degnan; Yuehwern Yih. 2019. "Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays." Journal of Patient Safety 15, no. 1: e8-e14.

Systems level quality improvement
Published: 12 February 2019 in Journal of Medical Systems
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Modern smart infusion pumps are wirelessly connected to a network server for easy data communications. The two-way communication allows uploading of infusion data and downloading of drug library updates. We have discovered significant delays in library updates. This research aimed at studying the drug library update process of one vendor pump and the contributing factors of pump update delays. Our data included BD Alaris™ pump status and infusion reports of two hospital systems (92 and 80 days, respectively, in 2015). We analyzed drug library update progressions at the individual device and fleet levels. To complete a library update, a pump goes through two status transitions: from noncurrent to a new library pending, and from pending to current. On average it took five to nine days for 50% of a pump fleet to become current after a new drug library was disseminated. We confirmed factors that affect noncurrent-to-pending time to include time to first power-on and total power-on time. We also found that high pump utilization promotes shorter pending-to-current time. Two distinctive and important steps of a drug library update on Alaris™ pumps are pending a new library and completing the library installation. To avoid potential patient harm caused by infusion pumps without appropriate drug limits due to update delays, hospitals should monitor the progression of a drug library update on its pump fleet. Potential ways to improve drug library updates on a fleet of pumps include better technologies, improved pump user-interface design, and more staff training.

ACS Style

Kang-Yu Hsu; Poching DeLaurentis; Yuehwern Yih; Yuval Bitan. Tracking the Progress of Wireless Infusion Pump Drug Library Updates– A Data-Driven Analysis of Pump Update Delays. Journal of Medical Systems 2019, 43, 75 .

AMA Style

Kang-Yu Hsu, Poching DeLaurentis, Yuehwern Yih, Yuval Bitan. Tracking the Progress of Wireless Infusion Pump Drug Library Updates– A Data-Driven Analysis of Pump Update Delays. Journal of Medical Systems. 2019; 43 (3):75.

Chicago/Turabian Style

Kang-Yu Hsu; Poching DeLaurentis; Yuehwern Yih; Yuval Bitan. 2019. "Tracking the Progress of Wireless Infusion Pump Drug Library Updates– A Data-Driven Analysis of Pump Update Delays." Journal of Medical Systems 43, no. 3: 75.

Research article
Published: 27 September 2018 in Proceedings of the Human Factors and Ergonomics Society Annual Meeting
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ACS Style

Yaar Harari; Raziel Riemer; Eli Jaffe; Oren Wacht; Yuval Bitan. The Relation Between the Paramedic’s Bags Location During Out-of-Hospital Resuscitation on Their Effort and Performance. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2018, 62, 938 -939.

AMA Style

Yaar Harari, Raziel Riemer, Eli Jaffe, Oren Wacht, Yuval Bitan. The Relation Between the Paramedic’s Bags Location During Out-of-Hospital Resuscitation on Their Effort and Performance. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2018; 62 (1):938-939.

Chicago/Turabian Style

Yaar Harari; Raziel Riemer; Eli Jaffe; Oren Wacht; Yuval Bitan. 2018. "The Relation Between the Paramedic’s Bags Location During Out-of-Hospital Resuscitation on Their Effort and Performance." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 62, no. 1: 938-939.

Journal article
Published: 01 August 2018 in American Journal of Health-System Pharmacy
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Purpose Results of a study to estimate the prevalence and severity of delays in wireless updates of smart-pump drug libraries across a large group of U.S. hospitals are reported. Methods A prolonged smart-pump drug library update may result in patient harm if a pump is programmed with an incorrect limit setting at the time of drug administration. A retrospective study was conducted using smart-pump alert data extracted from the Regenstrief National Center for Medical Device Informatics (REMEDI) database. The study sample consisted of 49 hospitals in 5 states across the Midwest and Kentucky operated by 12 health systems; all the facilities used a specific brand of smart pump (BD Alaris, Beckton, Dickinson and Company) capable of generating alert data and had consistently contributed alert data to the REMEDI database over a 2-year period. An update delay was defined as the interval from the time a drug library version was replaced to the time of the last infusion alert triggered by the previous version during the study period. Results Of the 12 health systems, 11 were found to have had drug library update delays during the study period, with delay medians ranging from 22 to 192 days. The overall delay minimum and maximum durations were 0 and 661 days. Conclusion Substantial delays in completion of wireless updates of smart-pump drug libraries were common across a group of hospitals of various sizes.

ACS Style

Poching DeLaurentis; Kang-Yu Hsu; Yuval Bitan. Prevalence of wireless smart-pump drug library update delays. American Journal of Health-System Pharmacy 2018, 75, 1140 -1144.

AMA Style

Poching DeLaurentis, Kang-Yu Hsu, Yuval Bitan. Prevalence of wireless smart-pump drug library update delays. American Journal of Health-System Pharmacy. 2018; 75 (15):1140-1144.

Chicago/Turabian Style

Poching DeLaurentis; Kang-Yu Hsu; Yuval Bitan. 2018. "Prevalence of wireless smart-pump drug library update delays." American Journal of Health-System Pharmacy 75, no. 15: 1140-1144.

Journal article
Published: 19 March 2018 in Australasian Journal of Paramedicine
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IntroductionThe correlation between patient outcomes and the safety culture in healthcare organisations draws special attention to tools that can measure safety culture in such organisations. One of the advantages of such tools is their ability to identify changes in safety climate, which can support healthcare organisations in detecting and understanding trends, which might have otherwise been overlooked. ObjectiveTo evaluate the ability of a standard survey to capture long-term safety climate changes in pre-hospital care. MethodsThe previously validated Emergency Medical Services Safety Attitudes Questionnaire was administered in one regional base hospital program, which delegates to six pre-hospital emergency care services. The survey was administered over two consecutive years, thus allowing us to measure safety climate changes over time. ResultsSignificant differences were found between the first and second years of the survey in specific services.ConclusionsWhile we cannot identify the specific causes for the change in scores in the various services between the two survey years, we can draw some inferences. We suggest that the small changes that tend to reflect a consistent change across all services are the result of training and educational initiatives, while greater changes in some of the services reflect a change in the attitude of the paramedics to the service, driven by changes in operational procedures within the service. Our findings demonstrate that the questionnaire can capture safety climate changes over time in pre-hospital emergency care.

ACS Style

Yuval Bitan; Philip Moran; James Harris. Evaluating safety culture changes over time with the Emergency Medical Services Safety Attitudes Questionnaire. Australasian Journal of Paramedicine 2018, 16, 1 .

AMA Style

Yuval Bitan, Philip Moran, James Harris. Evaluating safety culture changes over time with the Emergency Medical Services Safety Attitudes Questionnaire. Australasian Journal of Paramedicine. 2018; 16 ():1.

Chicago/Turabian Style

Yuval Bitan; Philip Moran; James Harris. 2018. "Evaluating safety culture changes over time with the Emergency Medical Services Safety Attitudes Questionnaire." Australasian Journal of Paramedicine 16, no. : 1.

Journal article
Published: 10 February 2017 in AMIA ... Annual Symposium proceedings. AMIA Symposium
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Interoperability is a major challenge in current healthcare systems. It brings big hope for data exchange, but also raises some concern about patient safety. We study the wireless updating of modern infusion pumps and demonstrate the possible flaws in this process. Through analyzing data on drug limit libraries (DLL) versions in one hospital we could identify the delays in distributing DLL updates and the impact these delays might have on patient safety. We found that 31% of all started infusions had used outdated DLL versions, and 22.6% of all alerts were triggered by outdated DLLs. These findings suggest that clinical and operational stakeholders in healthcare systems must address the unreliable interoperability of medical technologies such as seen on infusion pumps. The impact of information inconsistency across healthcare systems might result in use error which would impair patient safety.

ACS Style

Poching C DeLaurentis; Kang-Yu Hsu; Ana Isabel Hoz De La Armenta; Yuval Bitan. Investigating Delays in Updates to Infusion Pump Drug Limit Libraries. AMIA ... Annual Symposium proceedings. AMIA Symposium 2017, 2016, 490 -495.

AMA Style

Poching C DeLaurentis, Kang-Yu Hsu, Ana Isabel Hoz De La Armenta, Yuval Bitan. Investigating Delays in Updates to Infusion Pump Drug Limit Libraries. AMIA ... Annual Symposium proceedings. AMIA Symposium. 2017; 2016 ():490-495.

Chicago/Turabian Style

Poching C DeLaurentis; Kang-Yu Hsu; Ana Isabel Hoz De La Armenta; Yuval Bitan. 2017. "Investigating Delays in Updates to Infusion Pump Drug Limit Libraries." AMIA ... Annual Symposium proceedings. AMIA Symposium 2016, no. : 490-495.

Research article
Published: 15 September 2016 in Proceedings of the Human Factors and Ergonomics Society Annual Meeting
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We report the results of a study which aims to improve our understanding of how clinicians make sense of medication and disease information (medical reconciliation), performed by clinicians in a major US hospital. A card sorting simulation experiment running on an Android tablet was utilized to record the steps taken by 130 clinicians to reconcile and better understand the clinical information they received about a simulated patient. Evaluating the order in which the clinicians processed the information shows that most clinicians sorted medical condition information before medication history. Clinicians use diverse strategies to arrange the information. This study allows us to expend our understanding of the cognitive task of medication reconciliation, adding to the knowledge that might assist in data presentation in future medical information software. Such an understanding has the potential to provide clinicians with better tools to capture and reconcile clinical information which may ultimately improve patient safety.

ACS Style

Yuval Bitan; Yisrael Parmet; Geva Greenfield; Shelly Teng; Mark Nunnally. The Cognitive Task of Medication Reconciliation - Clinicians’ Approaches to the Arrangement of Medical Condition and Medication History Information. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2016, 60, 538 -540.

AMA Style

Yuval Bitan, Yisrael Parmet, Geva Greenfield, Shelly Teng, Mark Nunnally. The Cognitive Task of Medication Reconciliation - Clinicians’ Approaches to the Arrangement of Medical Condition and Medication History Information. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2016; 60 (1):538-540.

Chicago/Turabian Style

Yuval Bitan; Yisrael Parmet; Geva Greenfield; Shelly Teng; Mark Nunnally. 2016. "The Cognitive Task of Medication Reconciliation - Clinicians’ Approaches to the Arrangement of Medical Condition and Medication History Information." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 60, no. 1: 538-540.

Research article
Published: 01 June 2014 in Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care
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Introduction: High-stakes industries, such as healthcare, are complex systems prone to influence by various constraining factors. Expert practitioners in these domains work at the “sharp end” of these constraints and must reconcile limitations in the context of operations. When a major constraining factor is changed abruptly, it can induce a rapid sequence of adaptations. We observed the cognitive artifacts of post hoc signage, posted inside the space of the operating rooms of a new hospital facility, to help identify the way clinicians adapt to a new physical plant. Methods: In the first six months of operation of a new hospital facility, a clinician (MN) photographed signage posted on the operatory floor of the hospital. The photographs were classified into general categories to uncover the sorts of adaptive behaviors they represented. Results: We identified 28 signs that fit into four categories: way finding (7); appropriation and item localization (6); equipment activation, instruction and upkeep (9); and malfunction or breakage (6). Way finding and equipment activation, instruction and upkeep signs appeared earlier, and malfunction signs appeared later over the course of observation. Discussion: The physical layout of a building is a concrete example of operational constraints influencing clinical behavior (“sharp end”). Clinicians adapt to several needs when faced with a new workspace. Way finding and operational instructions are important components of this adaptation, but so too is resource appropriation. Physical failings of equipment become evident during operations, and the signage suggests that communicating these failures visually is important. The signs show the way clinicians adapt to constraints, effectively documenting the deficiencies in the interface between the physical structure and the people who work there. They are useful to direct research into new, helpful signage and also to signal the “brittle” aspects of the workplace. They should be celebrated as opportunities for improvement.

ACS Style

Mark E. Nunnally; Yuval Bitan. Ad hoc signage in a new hospital- a useful social tool and cognitive artifact. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 2014, 3, 99 -101.

AMA Style

Mark E. Nunnally, Yuval Bitan. Ad hoc signage in a new hospital- a useful social tool and cognitive artifact. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care. 2014; 3 (1):99-101.

Chicago/Turabian Style

Mark E. Nunnally; Yuval Bitan. 2014. "Ad hoc signage in a new hospital- a useful social tool and cognitive artifact." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 3, no. 1: 99-101.

Book chapter
Published: 12 September 2013 in Around the Patient Bed
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Dorit Sheffi; Yoel Donchin; Nurit Porat; Yuval Bitan; Daniel Gopher. Examining the Effectiveness of Using Designed Stickers for Labeling Drugs and Medical Tubing. Around the Patient Bed 2013, 20133841, 141 -152.

AMA Style

Dorit Sheffi, Yoel Donchin, Nurit Porat, Yuval Bitan, Daniel Gopher. Examining the Effectiveness of Using Designed Stickers for Labeling Drugs and Medical Tubing. Around the Patient Bed. 2013; 20133841 ():141-152.

Chicago/Turabian Style

Dorit Sheffi; Yoel Donchin; Nurit Porat; Yuval Bitan; Daniel Gopher. 2013. "Examining the Effectiveness of Using Designed Stickers for Labeling Drugs and Medical Tubing." Around the Patient Bed 20133841, no. : 141-152.