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

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

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• 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

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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.

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…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:

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…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

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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

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Human Factors: background

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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

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Human Factors: in healthcare

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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