Ergonomics in medicine and surgery
http://www.100md.com
《英国医生杂志》
1 Human Interface Technology Team, Department of Electronic, Electrical and Computer Engineering, University of Birmingham B15 2TT, 2 Clinical Research Divisions I and II, Surgery, University of Manchester M13 9WL
Correspondence to: R Stone r.j.stone@bham.ac.uk
This review outlines some of the issues surrounding ergonomics that are relevant to medical and surgical practice and to health care in general
Introduction
The discipline of ergonomics has attempted to make important changes over half a century by introducing human centred processes to the design of equipment, systems, and working practices in many domains of activity, including health care. This review is based on our experience in introducing ergonomics into medical research and development programmes, together with data taken from sources bridging medical, industrial, and defence communities, including information obtained through key texts, the UK Ergonomics Information Analysis Centre, the US Human Systems Information Analysis Center, and international ergonomics and medical websites.
Ergonomics
A report in 1999 suggested that at least 44 000 (and up to 98 000) people die in the United States each year from medical errors in hospitals (a figure greater than that recorded for road traffic fatalities, breast cancer, or AIDS).1 The US Food and Drug Administration has stated that although many of these fatalities cannot be attributed to human errors involving medical equipment or systems, some certainly can be.2 Other researchers have suggested that the incidence and outcome of errors arising from such interactions far exceed those resulting from electromechanical failures of those devices.3 4 These findings point to an absence of attention on the part of designers and developers to the ergonomic qualities of their products.
Ergonomics guidelines focusing on the design of medical devices and risk management have resulted from these efforts but are still not in widespread use.5 6 Nor have they been updated to reflect current ergonomics issues and the new generation of computerised systems. Furthermore, and despite their publication on the internet, the guidelines still remain unknown to many staff involved in the development of medical equipment throughout Europe.
Box 1: Components of ergonomics
To optimise system performance while maximising human wellbeing and operational effectiveness, ergonomics embraces a range of human centred issues relevant to equipment or systems design and training, including:
Body size (anthropometry), motion, and strength capabilities (biomechanics)
Sensory-motor capabilities—vision, hearing, haptics (force and touch), dexterity
Cognitive processes and memory (including situational awareness)
Training and current knowledge relating to equipment, systems, and practices
Training and current knowledge of medical conditions (including emergency conditions)
Expectations and cultural stereotypes relating to the operation of equipment
General health, age, motivation, stress levels, mental fatigue, performance under drug treatment or the effects of alcohol
Nevertheless, the term ergonomics continues to appear in marketing literature relating to products. On closer inspection it becomes evident that a formal, documented ergonomic approach to the design of, for example, an advanced operating theatre or surgical robot, has not been conducted and that evaluations involving end users are far from adequate. By offering operating rooms of the future, complete with multiple colour TVs, voice operated systems, support robots, ceiling mounted articulated arms, teleconferencing facilities, interactive three dimensional displays, and preoperative planning simulators in no way guarantees that these facilities are fit for human use.7 It is often impossible to find any evidence of qualified ergonomists on the development panels for these projects, a situation that is probably commonplace throughout the medical community. This is ironic considering the message issued by David Rattner, the director of the minimally invasive surgery programme for the US Center for Integration of Medicine and Innovative Technology:
Designing an operating room of the future, which will optimise the newest developments in surgery, requires much more than plugging in the new technologies. We are approaching the re-design at a systems level: how will different disciplines and different technologies work together to provide the best patient care environment?8
The only effective method of ensuring that medical technologies are fit for use and will not result in costly training or maintenance regimens is for practitioners to question the policy of companies to ascertain if ergonomics is a formal part of their development process and, specifically, if they can demonstrate the human centred rationale underpinning their products.
Accessing and exploiting knowledge of ergonomics
One example of the application of ergonomics techniques is a tool using computer graphics developed for the Institute of Naval Medicine by Virtalis to assist in the design of surgical environments on board ships (fig 1). The end users for this tool were not computer specialists and could not afford the time for in-depth training. They required an uncomplicated, low cost, and simplified method of accessing and manipulating ergonomics databases for the purpose of rapidly designing layouts for general triage and surgical compartments. They also required a means of implementing instant changes to those layouts during review meetings to meet the changing needs of their customers. This ergonomics tool is generic so it could be applied to a range of civilian medical and surgical applications, such as equipment design and the layout of hospital spaces or facilities within general medical practices.
Fig 1 Simple three dimensional computer graphics, or virtual reality tool, used to produce a basic ergonomic design for mini operating theatres on board Royal Navy vessels
The definition of end user requirements is not always as straightforward. In many instances, especially for those applications demanding innovative approaches to equipment and systems design or, increasingly, training programmes, it is necessary to analyse how the end users perform their tasks and exercise their experience and skills in real operational settings (see bmj.com). This task analysis is a key human centred process by which interactions between humans and their working environment can be formally described at a level appropriate to a predefined end goal (box 2). Without a properly executed task analysis, there is a risk of specifying or designing a system or piece of equipment that does not take account of the most relevant components of human skill (this is especially true for training regimens exploiting simulation technologies). In a medical or surgical setting, such an omission can lead to human error and, potentially, patient fatalities.
Box 2: Benefits of task analysis: the MIST system
One example of the benefits to be gained from a task analysis in a surgical setting is the minimally invasive surgical training system, MIST. The system, originally developed by the present authors, has been available as a technology based training product for laparoscopic surgery since 1997 (www.mentice.com).9 The simulator has also been the subject of a well documented range of experimental clinical and applied psychology studies during the late 1990s.10 11-13 The main reason for its success is that the early task analyses led to the development not of a highly detailed simulation of a virtual human body (requiring an expensive graphics supercomputer) but of a simplified skills trainer, presenting trainees with simple but relevant tasks ("task primitives") using a low cost, off the shelf personal computer, capable of generating objective records for students' performance (fig 2). Variations on the system are now appearing, such as the LapSim trainer (www.surgical-science.com). Despite the availability of increasingly sophisticated graphics, however, the use of task primitives for objective measures of training is still evident, showing the power of ergonomics and task analysis techniques in delivering meaningful and cost effective solutions to virtual reality training.
Fig 2 Minimally invasive surgical trainer, MIST, fosters laparoscopic skills by training on carefully selected task primitives (top right), designed after a psychological breakdown of perceptual and motor behaviours of observed surgeons
A task analysis can be carried out in many ways, yet there is no single, guaranteed formula.14 The type of analysis often depends on the human factors specialist involved, whether or not the task exists in reality or has yet to be designed, the goal of the analysis (new system design or new training procedures), the support of the end users, and any constraints imposed by the analysis environment. When there is a need for rapid results from analyses, the more popular techniques involve observation and interviews, often supplemented with video and audio records.10 Other techniques use quite sophisticated computer based solutions, from recording of data using mixed media (for example, video, computer keystrokes, physiological parameters, voice) to simulations based on models of human physical and psychological performance.
A successful example of a task analysis occurred in a project partly funded by the European Union. Project IERAPSI (integrated environment for the rehearsal and planning of surgical intervention) was designed to address advanced visualisation and training technologies for surgery of the temporal bone area of the skull—a common surgical site with complex anatomy.15 In collaboration with the ear, nose, and throat surgical teams at Manchester's Royal Infirmary, the Institute of Laryngology and Otology (University College London), and the University of Pisa, task analyses were undertaken on several surgical interventions, including cochlear implant, middle fossa, and translabyrinthine acoustic neuroma resection, each lasting an average of six hours and carried out by consultants. Detailed records of surgical performance were made under task headings, including bone exposure and drill site mark-up and superficial and deep bone drilling or burring procedures. Assessments were also conducted of contemporary training techniques, including the drilling of cadaveric bones (increasingly rare, due to limitations in availability), plastic temporal bone models (www.temporal-bone.com), and a Temporal Bone Dissector CD Rom.16
The results from the integrated environment for the rehearsal and planning of surgical intervention studies indicated that a simulator based on a realistic reproduction of the surgeon's interface (for example, microscope, drill, irrigator) was essential. The analysis also emphasised the importance of finding an appropriate interface device that would convey to trainee surgeons the difference in forces, vibrations, and tactile and sound effects as the virtual drill penetrated through various densities of bone (fig 3).
Fig 3 Procedures requiring the use of microscopes (top left) can lead to back pain, fibromyalgia, or tension headache in up to 80% of microscopists. Three dimensional graphic simulation of temporal bone area with virtual drill (bottom left). Trainee surgeons view the graphics with special binoculars (top right). They can sense the simulated drill effects using a pair of PHANToM haptic (force and touch) feedback hand controllers (bottom right) (www.sensable.com)
Conclusions
Despite the success of ergonomics in many areas, why has it yet to make a major contribution to health care? Evidence of a growing number of international websites outside Europe shows a growing commitment to introducing ergonomics in the workplace. One or two European organisations, such as Germany's Kommission Arbeitsschutz und Normung, have been proactive in the generation of ergonomics guidelines to make some of the emerging international standards more useful to those attempting to address hazards, risks, and usability in medical systems.17 However, many of the recommendations contained within the Kommission's reports have yet to be implemented on a continent wide basis and most do not yet deal with the ergonomic issues surrounding the more high tech systems. As Ramon Berguer, professor of surgery at the University of California-Davis and one of the pioneers in the application of ergonomics principles to surgical practice, stated:
A scientific and ergonomic approach to the analysis of the operating room environment and the performance and workload characteristics of members of the modern surgical team can provide a rational basis for maximizing the efficiency and safety of our increasingly technology-dependent surgical procedures18
Additional educational resources
Useful books
Boff KR, Lincoln JE. Engineering data compendium: human perception and performance. Ohio: Armstrong Aerospace Medical Research Laboratory (AARML) Wright-Patterson Air Force Base, 1988 (available from the Human Systems Information Analysis Center, HSIAC).
Bridger R. Introduction to ergonomics. London: Taylor and Francis, 2003
Karwowski W, ed. International encyclopaedia of ergonomics and human factors. London: Taylor and Francis, 2001
Useful websites
Ergonomics Society (UK) (www.ergonomics.org.uk/)—Home of the UK's principal source of information on ergonomics and related disciplines
California Division of Occupational Safety and Health (www.dir.ca.gov/dosh/puborder.asp)—A US website containing a substantial list of freely downloadable ergonomics guidelines and publications, including the popular Easy Ergonomics workplace design document
Ergonomics Information Analysis Centre (UK) (www.eee.bham.ac.uk/eiac/index.htm)—An international ergonomics information service based at the University of Birmingham
Human-Systems Information Analysis Center (US) (iac.dtic.mil/hsiac/)—A good resource for general human factors information, hosted at the US Air Force's Wright-Patterson base in Dayton
US Food and Drug Administration Human Factors Program (www.fda.gov/cdrh/humanfactors/index.html)—A relevant website containing useful information, publications, and links on human factors issues relating to usage of medical devices
rmis.com Resource Library (ergonomics and medicine) (www.rmlibrary.com/sites/ergmedic.htm)—A web resource containing ergonomics information predominantly relating to occupational health and trauma
The successful application or adoption of ergonomics demands commitment and participation from all levels of a healthcare organisation. The formation of an active ergonomics or human centred design programme within a hospital, health centre, or general practice is neither an onerous nor a costly task.19 However, the benefits of early adoption far outweigh the potential costs and consequences of ignoring the human factor for health service staff and patients alike.
Additional information is on bmj.com
Contributors: RS was responsible for the original text and revised drafts; he will act as guarantor for the paper. RMcC was responsible for the draft text and clinical review.
Funding: None.
Competing interests: None declared.
References
Kohn L, Corrigan J, Donaldson M, eds. To err is human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine, Washington, DC: National Academy Press, 1999.
Food and Drug Administration. Why is human factors engineering important for medical devices? www.fda.gov/cdrh/humanfactors/important.html (accessed 16 April 2004).
Cooper J. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984;60: 34-42.
Leape L. Error in medicine. JAMA 1994;21: 272.
Sawyer D. Do it by design: an introduction to human factors in medical devices. US Department of Health and Human Services Food and Drug Administration (Center for Devices and Radiological Health); Dec 1996.
Kaye R, Crowley J. Medical device use-safety: incorporating human factors engineering into risk management. US Department of Health and Human Services Food and Drug Administration (Center for Devices and Radiological Health);18 Jul 2000.
University of Pittsburgh Medical Center. University of Pittsburgh Medical Center opens operating room of the future, 9 Aug 2000. http://newsbureau.upmc.com/medsurg1/IntelligentorRoboticOr.htm (accessed 16 Apr 2004).
Centre for Integration of Medicine and Innovative Technology. The Operating Room of the Future (ORF) Project. http://www.cimit.org/orfuture.html (accessed 16 Apr 2004).
McCloy R, Stone R. Virtual reality in surgery. BMJ 2001;323: 912-5.
Stone R. The opportunities for virtual reality and simulation in the training and assessment of technical surgical skills. In Proceedings of surgical competence: challenges of assessment in training and practice, 2 Nov 1999. Royal College of Surgeons and Smith and Nephew Foundation: 109-25.
Sutton C, McCloy R, Middlebrook A, Chater P, Wilson M, Stone R. A laparoscopic surgery procedures trainer and evaluator. Proc Med Meets Virtual Reality 1997: 5.
Stone RJ. From engineering to surgery: the harsh realities of virtual reality. In: Akay M, Marsh A, eds. Information technologies in medicine, volume II: rehabilitation and treatment. London: John Wiley, 2001.
Grantcharov TP, Rosenberg J, Pahle E, Fuch-Jensen P. Virtual reality computer simulation: an objective method or evaluation of laparoscopic surgical skills. Surg Endosc 2001;15: 242-4.
Diaper D, Stanton NA, eds. The handbook of task analysis for human-computer interaction. Mahwah, MJ: Lawrence Erlbaum, 2003.
John NW, Thacker N, Pokric M, Jackson A, Zanetti G, Gobbetti E, et al. An integrated simulator for surgery of the petrous bone. Proc Med Meets Virtual Reality Amsterdam: IOS Press, 2001; 9.
Blevins NH, Jackler RK, Gralapp C. Temporal bone dissector: the interactive ontology reference. Mosby-Year Book CD Rom, 1997.
Kommission Arbeitsschutz und Normung. Report 7: European standards on ergonomics—status review and systematisation. www.kan.de/content/englishcontent/who_we_areactionfields/medical%20device.htm (accessed 16 Apr 2004).
Berguer R. The application of ergonomics in the work environment of general surgeons. Rev Environ Health 1997;12: 99-106.
Delano KT. Starting an HFE program. In: Proceedings of the HIMMS (Healthcare Information and Management Systems Society) 2003 Conference. www.himss.org/content/files/proceedings/2003/Sessions/session86_slides.pdf (accessed 16 Apr 2004).(Robert Stone, professor o)
Correspondence to: R Stone r.j.stone@bham.ac.uk
This review outlines some of the issues surrounding ergonomics that are relevant to medical and surgical practice and to health care in general
Introduction
The discipline of ergonomics has attempted to make important changes over half a century by introducing human centred processes to the design of equipment, systems, and working practices in many domains of activity, including health care. This review is based on our experience in introducing ergonomics into medical research and development programmes, together with data taken from sources bridging medical, industrial, and defence communities, including information obtained through key texts, the UK Ergonomics Information Analysis Centre, the US Human Systems Information Analysis Center, and international ergonomics and medical websites.
Ergonomics
A report in 1999 suggested that at least 44 000 (and up to 98 000) people die in the United States each year from medical errors in hospitals (a figure greater than that recorded for road traffic fatalities, breast cancer, or AIDS).1 The US Food and Drug Administration has stated that although many of these fatalities cannot be attributed to human errors involving medical equipment or systems, some certainly can be.2 Other researchers have suggested that the incidence and outcome of errors arising from such interactions far exceed those resulting from electromechanical failures of those devices.3 4 These findings point to an absence of attention on the part of designers and developers to the ergonomic qualities of their products.
Ergonomics guidelines focusing on the design of medical devices and risk management have resulted from these efforts but are still not in widespread use.5 6 Nor have they been updated to reflect current ergonomics issues and the new generation of computerised systems. Furthermore, and despite their publication on the internet, the guidelines still remain unknown to many staff involved in the development of medical equipment throughout Europe.
Box 1: Components of ergonomics
To optimise system performance while maximising human wellbeing and operational effectiveness, ergonomics embraces a range of human centred issues relevant to equipment or systems design and training, including:
Body size (anthropometry), motion, and strength capabilities (biomechanics)
Sensory-motor capabilities—vision, hearing, haptics (force and touch), dexterity
Cognitive processes and memory (including situational awareness)
Training and current knowledge relating to equipment, systems, and practices
Training and current knowledge of medical conditions (including emergency conditions)
Expectations and cultural stereotypes relating to the operation of equipment
General health, age, motivation, stress levels, mental fatigue, performance under drug treatment or the effects of alcohol
Nevertheless, the term ergonomics continues to appear in marketing literature relating to products. On closer inspection it becomes evident that a formal, documented ergonomic approach to the design of, for example, an advanced operating theatre or surgical robot, has not been conducted and that evaluations involving end users are far from adequate. By offering operating rooms of the future, complete with multiple colour TVs, voice operated systems, support robots, ceiling mounted articulated arms, teleconferencing facilities, interactive three dimensional displays, and preoperative planning simulators in no way guarantees that these facilities are fit for human use.7 It is often impossible to find any evidence of qualified ergonomists on the development panels for these projects, a situation that is probably commonplace throughout the medical community. This is ironic considering the message issued by David Rattner, the director of the minimally invasive surgery programme for the US Center for Integration of Medicine and Innovative Technology:
Designing an operating room of the future, which will optimise the newest developments in surgery, requires much more than plugging in the new technologies. We are approaching the re-design at a systems level: how will different disciplines and different technologies work together to provide the best patient care environment?8
The only effective method of ensuring that medical technologies are fit for use and will not result in costly training or maintenance regimens is for practitioners to question the policy of companies to ascertain if ergonomics is a formal part of their development process and, specifically, if they can demonstrate the human centred rationale underpinning their products.
Accessing and exploiting knowledge of ergonomics
One example of the application of ergonomics techniques is a tool using computer graphics developed for the Institute of Naval Medicine by Virtalis to assist in the design of surgical environments on board ships (fig 1). The end users for this tool were not computer specialists and could not afford the time for in-depth training. They required an uncomplicated, low cost, and simplified method of accessing and manipulating ergonomics databases for the purpose of rapidly designing layouts for general triage and surgical compartments. They also required a means of implementing instant changes to those layouts during review meetings to meet the changing needs of their customers. This ergonomics tool is generic so it could be applied to a range of civilian medical and surgical applications, such as equipment design and the layout of hospital spaces or facilities within general medical practices.
Fig 1 Simple three dimensional computer graphics, or virtual reality tool, used to produce a basic ergonomic design for mini operating theatres on board Royal Navy vessels
The definition of end user requirements is not always as straightforward. In many instances, especially for those applications demanding innovative approaches to equipment and systems design or, increasingly, training programmes, it is necessary to analyse how the end users perform their tasks and exercise their experience and skills in real operational settings (see bmj.com). This task analysis is a key human centred process by which interactions between humans and their working environment can be formally described at a level appropriate to a predefined end goal (box 2). Without a properly executed task analysis, there is a risk of specifying or designing a system or piece of equipment that does not take account of the most relevant components of human skill (this is especially true for training regimens exploiting simulation technologies). In a medical or surgical setting, such an omission can lead to human error and, potentially, patient fatalities.
Box 2: Benefits of task analysis: the MIST system
One example of the benefits to be gained from a task analysis in a surgical setting is the minimally invasive surgical training system, MIST. The system, originally developed by the present authors, has been available as a technology based training product for laparoscopic surgery since 1997 (www.mentice.com).9 The simulator has also been the subject of a well documented range of experimental clinical and applied psychology studies during the late 1990s.10 11-13 The main reason for its success is that the early task analyses led to the development not of a highly detailed simulation of a virtual human body (requiring an expensive graphics supercomputer) but of a simplified skills trainer, presenting trainees with simple but relevant tasks ("task primitives") using a low cost, off the shelf personal computer, capable of generating objective records for students' performance (fig 2). Variations on the system are now appearing, such as the LapSim trainer (www.surgical-science.com). Despite the availability of increasingly sophisticated graphics, however, the use of task primitives for objective measures of training is still evident, showing the power of ergonomics and task analysis techniques in delivering meaningful and cost effective solutions to virtual reality training.
Fig 2 Minimally invasive surgical trainer, MIST, fosters laparoscopic skills by training on carefully selected task primitives (top right), designed after a psychological breakdown of perceptual and motor behaviours of observed surgeons
A task analysis can be carried out in many ways, yet there is no single, guaranteed formula.14 The type of analysis often depends on the human factors specialist involved, whether or not the task exists in reality or has yet to be designed, the goal of the analysis (new system design or new training procedures), the support of the end users, and any constraints imposed by the analysis environment. When there is a need for rapid results from analyses, the more popular techniques involve observation and interviews, often supplemented with video and audio records.10 Other techniques use quite sophisticated computer based solutions, from recording of data using mixed media (for example, video, computer keystrokes, physiological parameters, voice) to simulations based on models of human physical and psychological performance.
A successful example of a task analysis occurred in a project partly funded by the European Union. Project IERAPSI (integrated environment for the rehearsal and planning of surgical intervention) was designed to address advanced visualisation and training technologies for surgery of the temporal bone area of the skull—a common surgical site with complex anatomy.15 In collaboration with the ear, nose, and throat surgical teams at Manchester's Royal Infirmary, the Institute of Laryngology and Otology (University College London), and the University of Pisa, task analyses were undertaken on several surgical interventions, including cochlear implant, middle fossa, and translabyrinthine acoustic neuroma resection, each lasting an average of six hours and carried out by consultants. Detailed records of surgical performance were made under task headings, including bone exposure and drill site mark-up and superficial and deep bone drilling or burring procedures. Assessments were also conducted of contemporary training techniques, including the drilling of cadaveric bones (increasingly rare, due to limitations in availability), plastic temporal bone models (www.temporal-bone.com), and a Temporal Bone Dissector CD Rom.16
The results from the integrated environment for the rehearsal and planning of surgical intervention studies indicated that a simulator based on a realistic reproduction of the surgeon's interface (for example, microscope, drill, irrigator) was essential. The analysis also emphasised the importance of finding an appropriate interface device that would convey to trainee surgeons the difference in forces, vibrations, and tactile and sound effects as the virtual drill penetrated through various densities of bone (fig 3).
Fig 3 Procedures requiring the use of microscopes (top left) can lead to back pain, fibromyalgia, or tension headache in up to 80% of microscopists. Three dimensional graphic simulation of temporal bone area with virtual drill (bottom left). Trainee surgeons view the graphics with special binoculars (top right). They can sense the simulated drill effects using a pair of PHANToM haptic (force and touch) feedback hand controllers (bottom right) (www.sensable.com)
Conclusions
Despite the success of ergonomics in many areas, why has it yet to make a major contribution to health care? Evidence of a growing number of international websites outside Europe shows a growing commitment to introducing ergonomics in the workplace. One or two European organisations, such as Germany's Kommission Arbeitsschutz und Normung, have been proactive in the generation of ergonomics guidelines to make some of the emerging international standards more useful to those attempting to address hazards, risks, and usability in medical systems.17 However, many of the recommendations contained within the Kommission's reports have yet to be implemented on a continent wide basis and most do not yet deal with the ergonomic issues surrounding the more high tech systems. As Ramon Berguer, professor of surgery at the University of California-Davis and one of the pioneers in the application of ergonomics principles to surgical practice, stated:
A scientific and ergonomic approach to the analysis of the operating room environment and the performance and workload characteristics of members of the modern surgical team can provide a rational basis for maximizing the efficiency and safety of our increasingly technology-dependent surgical procedures18
Additional educational resources
Useful books
Boff KR, Lincoln JE. Engineering data compendium: human perception and performance. Ohio: Armstrong Aerospace Medical Research Laboratory (AARML) Wright-Patterson Air Force Base, 1988 (available from the Human Systems Information Analysis Center, HSIAC).
Bridger R. Introduction to ergonomics. London: Taylor and Francis, 2003
Karwowski W, ed. International encyclopaedia of ergonomics and human factors. London: Taylor and Francis, 2001
Useful websites
Ergonomics Society (UK) (www.ergonomics.org.uk/)—Home of the UK's principal source of information on ergonomics and related disciplines
California Division of Occupational Safety and Health (www.dir.ca.gov/dosh/puborder.asp)—A US website containing a substantial list of freely downloadable ergonomics guidelines and publications, including the popular Easy Ergonomics workplace design document
Ergonomics Information Analysis Centre (UK) (www.eee.bham.ac.uk/eiac/index.htm)—An international ergonomics information service based at the University of Birmingham
Human-Systems Information Analysis Center (US) (iac.dtic.mil/hsiac/)—A good resource for general human factors information, hosted at the US Air Force's Wright-Patterson base in Dayton
US Food and Drug Administration Human Factors Program (www.fda.gov/cdrh/humanfactors/index.html)—A relevant website containing useful information, publications, and links on human factors issues relating to usage of medical devices
rmis.com Resource Library (ergonomics and medicine) (www.rmlibrary.com/sites/ergmedic.htm)—A web resource containing ergonomics information predominantly relating to occupational health and trauma
The successful application or adoption of ergonomics demands commitment and participation from all levels of a healthcare organisation. The formation of an active ergonomics or human centred design programme within a hospital, health centre, or general practice is neither an onerous nor a costly task.19 However, the benefits of early adoption far outweigh the potential costs and consequences of ignoring the human factor for health service staff and patients alike.
Additional information is on bmj.com
Contributors: RS was responsible for the original text and revised drafts; he will act as guarantor for the paper. RMcC was responsible for the draft text and clinical review.
Funding: None.
Competing interests: None declared.
References
Kohn L, Corrigan J, Donaldson M, eds. To err is human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine, Washington, DC: National Academy Press, 1999.
Food and Drug Administration. Why is human factors engineering important for medical devices? www.fda.gov/cdrh/humanfactors/important.html (accessed 16 April 2004).
Cooper J. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984;60: 34-42.
Leape L. Error in medicine. JAMA 1994;21: 272.
Sawyer D. Do it by design: an introduction to human factors in medical devices. US Department of Health and Human Services Food and Drug Administration (Center for Devices and Radiological Health); Dec 1996.
Kaye R, Crowley J. Medical device use-safety: incorporating human factors engineering into risk management. US Department of Health and Human Services Food and Drug Administration (Center for Devices and Radiological Health);18 Jul 2000.
University of Pittsburgh Medical Center. University of Pittsburgh Medical Center opens operating room of the future, 9 Aug 2000. http://newsbureau.upmc.com/medsurg1/IntelligentorRoboticOr.htm (accessed 16 Apr 2004).
Centre for Integration of Medicine and Innovative Technology. The Operating Room of the Future (ORF) Project. http://www.cimit.org/orfuture.html (accessed 16 Apr 2004).
McCloy R, Stone R. Virtual reality in surgery. BMJ 2001;323: 912-5.
Stone R. The opportunities for virtual reality and simulation in the training and assessment of technical surgical skills. In Proceedings of surgical competence: challenges of assessment in training and practice, 2 Nov 1999. Royal College of Surgeons and Smith and Nephew Foundation: 109-25.
Sutton C, McCloy R, Middlebrook A, Chater P, Wilson M, Stone R. A laparoscopic surgery procedures trainer and evaluator. Proc Med Meets Virtual Reality 1997: 5.
Stone RJ. From engineering to surgery: the harsh realities of virtual reality. In: Akay M, Marsh A, eds. Information technologies in medicine, volume II: rehabilitation and treatment. London: John Wiley, 2001.
Grantcharov TP, Rosenberg J, Pahle E, Fuch-Jensen P. Virtual reality computer simulation: an objective method or evaluation of laparoscopic surgical skills. Surg Endosc 2001;15: 242-4.
Diaper D, Stanton NA, eds. The handbook of task analysis for human-computer interaction. Mahwah, MJ: Lawrence Erlbaum, 2003.
John NW, Thacker N, Pokric M, Jackson A, Zanetti G, Gobbetti E, et al. An integrated simulator for surgery of the petrous bone. Proc Med Meets Virtual Reality Amsterdam: IOS Press, 2001; 9.
Blevins NH, Jackler RK, Gralapp C. Temporal bone dissector: the interactive ontology reference. Mosby-Year Book CD Rom, 1997.
Kommission Arbeitsschutz und Normung. Report 7: European standards on ergonomics—status review and systematisation. www.kan.de/content/englishcontent/who_we_areactionfields/medical%20device.htm (accessed 16 Apr 2004).
Berguer R. The application of ergonomics in the work environment of general surgeons. Rev Environ Health 1997;12: 99-106.
Delano KT. Starting an HFE program. In: Proceedings of the HIMMS (Healthcare Information and Management Systems Society) 2003 Conference. www.himss.org/content/files/proceedings/2003/Sessions/session86_slides.pdf (accessed 16 Apr 2004).(Robert Stone, professor o)