The health and well-being sector has been of significant interest to the behavioural design domain since bringing in behavioural changes can help improve the overall well-being of a community. However, the domain's intervention in this sector has been limited to persuasive techniques for the adoption of healthier lifestyles. There is a need to consider the diagnostic actions and decisions undertaken by doctors as it represents an important part of health and well-being improvement of people. Medical errors committed by healthcare professionals are an important aspect of the healthcare domain. Since these errors result due to undesired or non-normative behaviours, behavioural design can be instrumental in their eradication. But the research on integrating behavioural design and medical error literature is still nascent.

In this paper, we address this gap by identifying the categories of errors based on the performance levels within which they occur. Next, we contextualise these errors categories to medical literature focusing on the diagnostic stage. We further link it to the behavioural change model of COM-B to determine preliminary intervention functions that can be utilised by behavioural designers to deploy interventions.

Objective: To characterize the performance of glucose meter test strips using simulated dynamic temperature and humidity disaster conditions.

Methods: Glucose oxidase- and glucose dehydrogenase-based test strips were dynamically stressed for up to 680 hours using an environmental chamber to simulate conditions during Hurricane Katrina. Paired measurements vs control were obtained using 3 aqueous reagent levels for GMS1 and 2 for GMS2.

Results: Stress affected the performance of GMS1 at level 1 (P <. 01); and GMS2 at both levels (P <. 001), lowering GMS1 results but elevating GMS2 results. Glucose median-paired differences were elevated at both levels on GMS2 after 72 hours. Median-paired differences (stress minus control) were as much as −10 mg/dL (range, −65 to 33) at level 3 with GMS1, with errors as large as 21.9%. Glucose median-paired differences were as high as 5 mg/dL (range, −1 to 10) for level 1 on GMS2, with absolute errors up to 24.4%.

Conclusions: The duration of dynamic stress affected the performance of both GMS1 and GMS2 glucose test strips. Therefore, proper monitoring, handling, and storage of point-of-care (POC) reagents are needed to ensure their integrity and quality of actionable results, thereby minimizing treatment errors in emergency and disaster settings.

(Disaster Med Public Health Preparedness. 2012;6:232–240)

Summary

Background and objective: In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA).

Methods: A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001.

Results: Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be other-wise found in a handbook. The choice of a less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important.

Conclusions: This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.

The last decade has witnessed a rapidly growing public and academic interest in medical error, an interest that has culminated in the emergence of the science of error prevention in health care. The impact of this new science will be felt in all areas of medicine but perhaps especially in emergency medicine (EM). The emergency department’s unique operating characteristics make it a natural laboratory for the study of error. These characteristics, combined with the complex and myriad activities of EM, predict vulnerability to a multitude of errors. Overcrowding and other resource limitations impair continuous quality improvement, and many errors result from high decision density, excessive cognitive load and flawed thinking in the decision-making process. A large proportion of these errors have serious outcomes but an even higher proportion are preventable.

The historical practice of blaming individuals for errors needs to be replaced by root-cause analysis that identifies process and systemic weaknesses. Quantitative and qualitative methods are needed to detect, describe and classify error at all levels in the system. Research is needed into the processes that underlie EM error. Educational initiatives should be developed at all levels, for everyone from undergraduate trainees to practicing emergency physicians. Changes in societal attitudes will be an important component of the new culture of patient safety.

A nationwide reporting system is proposed to disseminate error information expediently. Canadian EM providers are in a pivotal position to provide leadership to the Canadian health care system in this important area.