Presentation
HE1 - "Pulse Check": Creating Human Factors Guidelines for Wider Impact in Remote Cardiac Telemetry Monitoring
SessionPoster Session 1
DescriptionWhat is Remote Cardiac Telemetry Monitoring?
Remote cardiac telemetry monitoring is becoming more prevalent and adopted in healthcare systems to provide continuous, real-time monitoring of patients’ cardiac rhythms and other critical physiological measures for early detection of arrhythmias and other concerning physiological changes, thus enabling timely interventions.
Monitoring technicians (MTs) track the cardiac rhythms of multiple patients via chest-attached electrodes that transmit data to centralized screens, alerting nurses to any reportable event. Additionally, MTs’ responsibilities often include secondary tasks such as rhythm strip documentation and replacing batteries in telebox monitors used throughout the hospital (Funk et al., 2016).
Current Challenges
Implementing telemetry systems is complex and presents numerous human factors challenges on the MTs role, such as managing high workload, vigilance, and communication with frontline staff (Fisk & Schneider, 2016; Nare & Hancock, 2021; Mackworth, 2008; Warm et al., 2008). Technological limitations, alarm fatigue, inconsistencies in communication technologies, and policies between MTs and clinical staff add to the complexity of centralized monitoring, threatening patient safety (Funk et al., 2016) . However, decisions regarding the setup can frequently be influenced by factors other than safety. These challenges highlight the need for developing guidelines and standard best practices to ensure that telemetry monitoring tasks do not exceed human capabilities.
Prior Work & Methods
Presentations at recent International Symposiums on Human Factors and Ergonomics in Health Care highlighted how human factors principles can address challenges in centralized cardiac telemetry monitoring, such as MTs’ mental workload, screen layout, and attention, revealing a shared need for collaboration across hospital systems (Jamil, 2020; Sanghavi, 2022; Nystrom et al., 2023; Peng et al., 2023).
Beginning in 2023, a collaborative group of Human Factors practitioners and researchers from various U.S. healthcare systems convened to address challenges hospital systems face when implementing centralized cardiac telemetry monitoring. The group identified that these challenges could be addressed through a set of guidelines grounded in human factors research, translating principles such as vigilance, interface design, and team communication into a practical resource, especially for hospitals lacking dedicated human factors expertise.
This work was presented to the International Symposium on Human Factors and Ergonomics in Health Care in 2024, where we elicited feedback from participants who attended that session (Butler et. al, 2024). Since then, we have reorganized and reworked our previous themes based on comments and suggestions collected from the 2024 presentation.
To date, we are in the process of refining each guideline based on our final themes, findings from relevant literature, and our collective experience. In the near future, we will be sharing the guidelines with cardiac telemetry leadership and teams to elicit their feedback on the format of the guidelines, their interpretation of each guideline, and their ideas for mechanisms to deliver these guidelines to telemetry caregivers and administrators whose practice will benefit from them.
Goals
Provide an update on the developed guidelines with an example
Present through this work, strategies for creating practical socio-technical guidelines that are accessible and applicable for healthcare systems’ leadership teams.
Elicit feedback from fellow HFEs to gain insights on the most effective ways to phrase and publish this type of socio-technical guideline as well as get more embedded HFE to get involved.
Results & Conclusion
Refining Guidelines through Conference Feedback
The feedback solicited from the panel session at the International Symposium on Human Factors and Ergonomics in Health Care in 2024 focused on guideline structuring, content, and publication avenues (Butler et al., 2024). Suggestions on guideline structure and content informed a review of the existing affinity diagram, resulting in adjustments to enhance its clarity and alignment with our goals. To improve the format of the guideline, attendees recommended including an executive summary to highlight key recommendations and adding a one-page implementation guide that outlines a sample guideline from a user’s perspective. Additionally, the value of employing systems thinking to depict interactions between telemetry technicians, setups, and organizational elements was emphasized, along with considering AI's growing role in telemetry monitoring.
Poster Content & Goals
To show our progress and how these guidelines can be implemented, we will display our final detailed groupings of guidelines, key guidelines and examples of their application in our institutions. This will not only show how the format is unique compared to more technical guidelines, but also illustrate the challenges of writing guidelines that are both specific enough to convey detailed human factors expertise while still being able to be implemented in organizations that may not have a human factors professional to translate the guidelines to their local context.
For example, one guideline under “Workflow and Secondary Tasks” states Consider task rotation as a job design strategy to combat vigilance decrement in monitoring tasks. For telemetry techs co-located with patient care areas, this could be rotating patient cares with monitoring. For centralized techs, this could include rotating through inventory management, cleaning, routine strip printing and measuring with monitoring.”
One organization chose to implement this by grouping secondary tasks. When one tech steps away to make calls on all expiring telemetry orders and clean equipment they handoff the patients they are monitoring amongst the remaining techs so they can truly step away and not experience the performance decrement seen with task switching. Another organization chose to co-locate the monitor tech room near a unit in which all their support staff are also cross trained in telemetry monitoring so that frequent short breaks can be provided to the single monitoring tech throughout the day.
References:
Fisk, A. D., & Schneider, W. (2016). Control and automatic processing during tasks requiring sustained attention: A new approach to vigilance. Human Factors, 23(6), 737–750. https://doi.org/10.1177/001872088102300610
Funk, M., Ruppel, H., Blake, N., & Phillips, J. (2016). Research: Use of monitor watchers in hospitals: Characteristics, training, and practices. Biomedical Instrumentation & Technology, 50(6), 428–438. https://doi.org/10.2345/0899-8205-50.6.428
Jamil, M. (2020, May 18-21). Don't Miss a Beat: Understanding Complex System Factors to Improve Cardiac Telemetry Patient Safety [Conference Presentation]. 2020 International Symposium on Human Factors and Ergonomics in Health Care, Virtual Symposium. https://higherlogicdownload.s3.amazonaws.com/HFES/42fffbb4-31e1-4e52-bda6-1393762cbfcd/UploadedImages/2020_HCS/Health_Care_Symposium_Program_as_of_May_15_2020.pdf
Nare, M. T. & Hancock, G. M. (2021). Vigilance in cardiac telemetry monitoring: Performance outcomes and effects on operators’ cognitive and affective states. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 10(1), 223–228. https://doi.org/10.1177/2327857921101143
Nystrom, D., Thomas, J., Jones, C. (2023, March 26-29). Preliminary Evaluation of Cardiac Telemetry Technician Work in a Large Health System: Mutual Dependence and Considerations for Patient Load [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Peng, Y., Sanghavi, H., Jesso, M., Wolf, L. (2023, March 26-29). Everything, Everywhere, All at Once: Remote Telemetry Monitoring Performance (Response Time, Error Rate and Perceived Workload). [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Mackworth, N. H. (2008). The breakdown of vigilance during prolonged visual search. Quarterly Journal of Experimental Psychology, April 2012, 37–41. https://doi.org/https://doi.org/10.1080/17470214808416738
Sanghavi, H., Peng, Y., Jesso, M., Wolf, L. (2022, March 20-23). Remote Telemetry Monitoring Task: obtaining Baseline Performance. [Conference Presentation]. 2022 International Symposium on Human Factors and Ergonomics in Health Care, New Orleans, LA, United States.
Warm, J. S., Parasuraman, R., & Matthews, G. (2008). Vigilance requires hard mental work and is stressful. Human Factors, 50(3), 433–441. https://doi.org/10.1518/001872008X312152
Remote cardiac telemetry monitoring is becoming more prevalent and adopted in healthcare systems to provide continuous, real-time monitoring of patients’ cardiac rhythms and other critical physiological measures for early detection of arrhythmias and other concerning physiological changes, thus enabling timely interventions.
Monitoring technicians (MTs) track the cardiac rhythms of multiple patients via chest-attached electrodes that transmit data to centralized screens, alerting nurses to any reportable event. Additionally, MTs’ responsibilities often include secondary tasks such as rhythm strip documentation and replacing batteries in telebox monitors used throughout the hospital (Funk et al., 2016).
Current Challenges
Implementing telemetry systems is complex and presents numerous human factors challenges on the MTs role, such as managing high workload, vigilance, and communication with frontline staff (Fisk & Schneider, 2016; Nare & Hancock, 2021; Mackworth, 2008; Warm et al., 2008). Technological limitations, alarm fatigue, inconsistencies in communication technologies, and policies between MTs and clinical staff add to the complexity of centralized monitoring, threatening patient safety (Funk et al., 2016) . However, decisions regarding the setup can frequently be influenced by factors other than safety. These challenges highlight the need for developing guidelines and standard best practices to ensure that telemetry monitoring tasks do not exceed human capabilities.
Prior Work & Methods
Presentations at recent International Symposiums on Human Factors and Ergonomics in Health Care highlighted how human factors principles can address challenges in centralized cardiac telemetry monitoring, such as MTs’ mental workload, screen layout, and attention, revealing a shared need for collaboration across hospital systems (Jamil, 2020; Sanghavi, 2022; Nystrom et al., 2023; Peng et al., 2023).
Beginning in 2023, a collaborative group of Human Factors practitioners and researchers from various U.S. healthcare systems convened to address challenges hospital systems face when implementing centralized cardiac telemetry monitoring. The group identified that these challenges could be addressed through a set of guidelines grounded in human factors research, translating principles such as vigilance, interface design, and team communication into a practical resource, especially for hospitals lacking dedicated human factors expertise.
This work was presented to the International Symposium on Human Factors and Ergonomics in Health Care in 2024, where we elicited feedback from participants who attended that session (Butler et. al, 2024). Since then, we have reorganized and reworked our previous themes based on comments and suggestions collected from the 2024 presentation.
To date, we are in the process of refining each guideline based on our final themes, findings from relevant literature, and our collective experience. In the near future, we will be sharing the guidelines with cardiac telemetry leadership and teams to elicit their feedback on the format of the guidelines, their interpretation of each guideline, and their ideas for mechanisms to deliver these guidelines to telemetry caregivers and administrators whose practice will benefit from them.
Goals
Provide an update on the developed guidelines with an example
Present through this work, strategies for creating practical socio-technical guidelines that are accessible and applicable for healthcare systems’ leadership teams.
Elicit feedback from fellow HFEs to gain insights on the most effective ways to phrase and publish this type of socio-technical guideline as well as get more embedded HFE to get involved.
Results & Conclusion
Refining Guidelines through Conference Feedback
The feedback solicited from the panel session at the International Symposium on Human Factors and Ergonomics in Health Care in 2024 focused on guideline structuring, content, and publication avenues (Butler et al., 2024). Suggestions on guideline structure and content informed a review of the existing affinity diagram, resulting in adjustments to enhance its clarity and alignment with our goals. To improve the format of the guideline, attendees recommended including an executive summary to highlight key recommendations and adding a one-page implementation guide that outlines a sample guideline from a user’s perspective. Additionally, the value of employing systems thinking to depict interactions between telemetry technicians, setups, and organizational elements was emphasized, along with considering AI's growing role in telemetry monitoring.
Poster Content & Goals
To show our progress and how these guidelines can be implemented, we will display our final detailed groupings of guidelines, key guidelines and examples of their application in our institutions. This will not only show how the format is unique compared to more technical guidelines, but also illustrate the challenges of writing guidelines that are both specific enough to convey detailed human factors expertise while still being able to be implemented in organizations that may not have a human factors professional to translate the guidelines to their local context.
For example, one guideline under “Workflow and Secondary Tasks” states Consider task rotation as a job design strategy to combat vigilance decrement in monitoring tasks. For telemetry techs co-located with patient care areas, this could be rotating patient cares with monitoring. For centralized techs, this could include rotating through inventory management, cleaning, routine strip printing and measuring with monitoring.”
One organization chose to implement this by grouping secondary tasks. When one tech steps away to make calls on all expiring telemetry orders and clean equipment they handoff the patients they are monitoring amongst the remaining techs so they can truly step away and not experience the performance decrement seen with task switching. Another organization chose to co-locate the monitor tech room near a unit in which all their support staff are also cross trained in telemetry monitoring so that frequent short breaks can be provided to the single monitoring tech throughout the day.
References:
Fisk, A. D., & Schneider, W. (2016). Control and automatic processing during tasks requiring sustained attention: A new approach to vigilance. Human Factors, 23(6), 737–750. https://doi.org/10.1177/001872088102300610
Funk, M., Ruppel, H., Blake, N., & Phillips, J. (2016). Research: Use of monitor watchers in hospitals: Characteristics, training, and practices. Biomedical Instrumentation & Technology, 50(6), 428–438. https://doi.org/10.2345/0899-8205-50.6.428
Jamil, M. (2020, May 18-21). Don't Miss a Beat: Understanding Complex System Factors to Improve Cardiac Telemetry Patient Safety [Conference Presentation]. 2020 International Symposium on Human Factors and Ergonomics in Health Care, Virtual Symposium. https://higherlogicdownload.s3.amazonaws.com/HFES/42fffbb4-31e1-4e52-bda6-1393762cbfcd/UploadedImages/2020_HCS/Health_Care_Symposium_Program_as_of_May_15_2020.pdf
Nare, M. T. & Hancock, G. M. (2021). Vigilance in cardiac telemetry monitoring: Performance outcomes and effects on operators’ cognitive and affective states. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 10(1), 223–228. https://doi.org/10.1177/2327857921101143
Nystrom, D., Thomas, J., Jones, C. (2023, March 26-29). Preliminary Evaluation of Cardiac Telemetry Technician Work in a Large Health System: Mutual Dependence and Considerations for Patient Load [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Peng, Y., Sanghavi, H., Jesso, M., Wolf, L. (2023, March 26-29). Everything, Everywhere, All at Once: Remote Telemetry Monitoring Performance (Response Time, Error Rate and Perceived Workload). [Conference Presentation]. 2023 International Symposium on Human Factors and Ergonomics in Health Care, Orlando Florida, United States. https://www.hcs-2023.org/_files/ugd/3b7267_9783abe93079496c8418263ada2af96b.pdf
Mackworth, N. H. (2008). The breakdown of vigilance during prolonged visual search. Quarterly Journal of Experimental Psychology, April 2012, 37–41. https://doi.org/https://doi.org/10.1080/17470214808416738
Sanghavi, H., Peng, Y., Jesso, M., Wolf, L. (2022, March 20-23). Remote Telemetry Monitoring Task: obtaining Baseline Performance. [Conference Presentation]. 2022 International Symposium on Human Factors and Ergonomics in Health Care, New Orleans, LA, United States.
Warm, J. S., Parasuraman, R., & Matthews, G. (2008). Vigilance requires hard mental work and is stressful. Human Factors, 50(3), 433–441. https://doi.org/10.1518/001872008X312152
Authors
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)