Directed by Matthew B. Weinger, M.D., CRISS is highly interdisciplinary and collaborative with projects spanning numerous clinical domains (from the Medical Home to the operating room) and disciplines (medicine, nursing, and pharmacy). Using a range of human factors and systems engineering, cognitive psychology, biomedical informatics, and implementation science techniques, CRISS studies performance during patient care and in realistic simulations to better understand how and why care deviates from optimal. Interventions are then designed and evaluated to improve the safety and quality of care. CRISS is actively involved in improving the user interfaces of Vanderbilt’s custom clinical information systems, evaluating and redesigning processes and tools to enhance patient safety and quality care, as well as furnishing graphic design services for research and clinical endeavors.
CRISS investigators are particularly interested in designing and evaluating medical technologies (i.e., devices and information systems) with an emphasis on the effects of the introduction of new technologies on clinical care and the use of electronically generated clinical data to identify evolving events and support decision-making. We also conduct studies to understand the causes of unexpected clinical events and how such events might be prevented.
At the conceptual level, CRISS scientists are interested in the nature of expertise, clinician-clinician communication, novel methods of information presentation, the workload and stress of individual clinicians and of teams, situational awareness, and various other intrinsic and extrinsic variables that affect performance during routine and non-routine clinical care. CRISS investigators are also interested in team communication, coordination, culture and effectiveness, human-technology interactions, adaptive problem solving, as well as individual and group performance-shaping factors, to generate practical benefits in terms of improved clinical care processes and outcomes.
Because of increasing scope and impact outside the operating room and across multiple healthcare domains, the Center for Perioperative Research in Quality (CPRQ), founded in 2005, was renamed in October 2010 to be the Center for Research and Innovation in Systems Safety. CRISS remains located within the Department of Anesthesiology, and is an integral part of Vanderbilt’s Institute for Medicine and Public Health (IMPH), lead by Dr. Robert Dittus. CRISS is an institution-wide resource for human factors and systems design and improvement in healthcare. The Center also subsumed the functions of Vanderbilt’s Center for Improving Patient Safety (CIPS), previously co-directed by Drs. Dittus and Weinger.
Dr. France is leading a team that received a 4-year grant from the National Institute for Childhood Health and Human Development (NICHD) to understand the risks to the safety of surgical neonates. The focus of this project is on care transitions (to and from the neonatal intensive care unit and the operating room). The successful acquisition of this grant was in part due to the prior efforts of Dr. Lorinc who is completing a study, funded by the Foundation for Anesthesia Education and Research (FAER), in which she documented deficiencies in the care transitions of neonates from NICU to OR, created an new handover process using participatory design, and appears to have significantly improved the process.
Dr. Anders is the lead on a project funded by the Department of Energy (DOE, Weinger, PI) to assist the nuclear power industry in modernizing the instrumentation in the NP main control room. In this project, we are developing and validating meta-level design guidance for NP operator situation awareness and decision-making relevant to the design of digital user interface (UI) components intended for hybrid (i.e., mix of analog and digital controls and displays) NP control rooms (HCRs); 2) Identifying and validating measures of operator performance during emergency simulations; and 3) Create and evaluate a simulation scenario ontology for the selection of scenarios to evaluate new digital UI component designs.
Recently, CRISS started a collaboration with Charles River Analytics, lead by Dr. Xu, to conduct a study (funded by the US Army) to evaluate a combined head-worn and armband sensor array to assess cognitive and physical workload during simulated clinical emergencies by healthcare teams.
In a study funded by the Patient Centered Outcomes Research Institute (PCORI, Weinger, PI), we have demonstrated the value of concurrently collecting quality and safety information from patients/families and their clinicians in four different clinical domains. We studied 384 patients in 559 clinical encounters. In 51% of these encounters, clinicians reported a non-routine event (NRE). In 43% of the encounters, a patient or family member reported a NRE — many of these NREs were actually unknown to the clinicians yet appeared relevant to their patients’ health. Data analysis is ongoing.
In an AHRQ-funded study (Weinger, PI), 9 sites and 15 multidisciplinary investigators were engaged to study the clinical performance of board-certified anesthesiologists during the management of simulated medical emergencies. The team developed standardized simulation scenarios with associated valid, reliable performance assessment tools and processes; demonstrated that simulation-based clinical assessment can be reliably delivered across multiple national sites; and demonstrated significant gaps in the performance during simulation of a diverse cross-section of board-certified physicians. As a spin-off of this project, Dr. Banerjee is leading a study of how raters’ continuous (moment-to-moment) ratings correlate with summative (global) ratings to examine the nature of cognitive biases during performance ratings. In a related project, Dr. Watkins studied the reliability of raters using ANTS vs. the BARS (the rating tool developed in the AHRQ study) observing videos of teams performing in simulated pediatric emergencies and found that the BARS was more reliable, even for non-domain expert raters.
Dr. Slagle is wrapping up a study of the effects of self-induced distractions and externally mediated interruptions during anesthesia care.
Dr. Schlesinger is studying domain-relevant responses to existing and novel alarms in a sophisticated computer-controlled paradigm in the anechoic chamber in the Vanderbilt Bill Wilkerson Center.
In a VA HSRD-funded 5-site study (Weinger, PI), CRISS faculty analyzed data from 1,000 patient cases to assess the relationship between clinician workload, the occurrence of intraoperative events, and patient major morbidity and mortality. The surgical team’s pre- and post-case workload ratings were strongly associated with reported intraoperative events and with 30-day morbidity and mortality.
CRISS members are also actively involved in VUMC operational initiatives in quality improvement (QI) and informatics. For example, on the QI side, Dr. France is supporting the Department of Quality, Safety, and Risk Prevention (QSRP) in efforts to measure and report hospital safety culture, and to disseminate (publish) methods and findings resulting from VUMC’s fall prevention initiative.
For VUMC informatics, under the leadership of Dr. Anders we are now assisting HealthIT and the EpicLeap transition team with usability assessments and user testing of Epic modules during the build phase. Recently, the CRISS team (particularly Beebe and Reale) were integrally involved in user interface design and evaluation on numerous application teams, including Vanderbilt Outpatient Order Management (VOOM), MessageBasket, StarPanel Customized Views, Reliable Results Reporting, VPIMS applications, and tools to support surgical timeouts, handovers and debriefings.
CRISS also has a contract with the Department of Veterans Affairs Office of Information Analytics to assist in the human factors engineering and user-centered design processes around the VA’s new EHR, called its enterprise Health Management Platform (eHMP).
CRISS faculty and staff provide other CTSA/VICTR investigators with core support and guidance in theories, methods and tools related to human factors, industrial and systems engineering, user interface design and evaluation, process re-engineering, implementation science, simulation-based training and assessment, safety culture and associated survey methods, and related areas.