Manual Overrides Research Articles

So Many Barcodes, So Little Time: A Quality Improvement Project to Improve Scanning of Blood Product Bags

Background Incorrect administration of blood products is a critical concern, occurring once in every 12,000 units transfused in the United States. Blood product documentation and scanning are vital for patient safety, yet difficulties in scanning multiple barcodes on blood transfusion bags often lead to delays and the need for manual overrides. Methods This quality improvement project utilized the PDCA (Plan-Do-Check-Act) cycle of improvement to address blood product scanning in a 495-bed hospital in New York City. Results The scanning rate for blood products increased significantly from 69% in January 2021 to 96% in May 2021, representing a 39% improvement. Subsequently, increased compliance in 2022 demonstrated sustainment of best practices. Conclusions Implementation of the PDCA method led to increased compliance in scanning blood product bags following barcode scanner recalibration.

Dosimetric significance of manual density overrides in oropharyngeal cancer

Kilovoltage computed tomography plays a crucial role in radiotherapy planning. However, the presence of high-density metallic objects can introduce streaking artifacts in CT scans, resulting in inaccurate dose calculations by the treatment planning software. Previous studies have explored manual density overrides and artifact reduction algorithms individually to enhance dose calculation accuracy, but their combined application on patient plans within a treatment planning system remains unexplored. This research aims to assess the necessity of manual density overrides when an artifact reduction algorithm is already employed to address dental artifacts in oropharyngeal cancer treatment plans. A total of 20 previously treated volumetric modulated arc therapy plans were collected, and manual density overrides were removed followed by plan recalculation. Dosimetric parameters were then compared between the original and modified plans. Statistical analysis revealed several dosimetric parameters for the planning target volume (PTV), clinical target volume (CTV), and oral cavity that exhibited statistically significant differences upon removing the manual density override. However, these differences were found to be small in absolute terms. No other organs evaluated demonstrated statistically significant differences in dose. The most significant disparity observed was an 8.26 cGy increase in mean dose to the CTV, which represents only 0.12% of the prescription dose. Based on these findings, it can be concluded that manual density overrides are likely unnecessary when an artifact reduction algorithm is employed in oropharyngeal cancer cases.

Data-based program management of system-wide IV smart pump integration.

Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system. Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical's Plum 360 and LifeCare PCA devices and Smith Medical's MedFusion 4000 Syringe Pump devices. The hospital system's experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates. The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability.

Synthetic CT generation for MRI-guided adaptive radiotherapy in prostate cancer.

Current MRI-guided adaptive radiotherapy (MRgART) workflows require fraction-specific electron and/or mass density maps, which are created by deformable image registration (DIR) between the simulation CT images and daily MR images. Manual density overrides may also be needed where DIR-produced results are inaccurate. This approach slows the adaptive radiotherapy workflow and introduces additional dosimetric uncertainties, especially in the presence of the magnetic field. This study investigated a method based on a conditional generative adversarial network (cGAN) with a multi-planar method to generate synthetic CT images from low-field MR images to improve efficiency in MRgART workflows for prostate cancer. Fifty-seven male patients, who received MRI-guided radiation therapy to the pelvis using the ViewRay MRIdian Linac, were selected. Forty-five cases were randomly assigned to the training cohort with the remaining twelve cases assigned to the validation/testing cohort. All patient datasets had a semi-paired DIR-deformed CT-sim image and 0.35T MR image acquired using a true fast imaging with steady-state precession (TrueFISP) sequence. Synthetic CT images were compared with deformed CT images to evaluate image quality and dosimetric accuracy. To evaluate the dosimetric accuracy of this method, clinical plans were recalculated on synthetic CT images in the MRIdian treatment planning system. Dose volume histograms for planning target volumes (PTVs) and organs-at-risk (OARs) and dose distributions using gamma analyses were evaluated. The mean-absolute-errors (MAEs) in CT numbers were 30.1 ± 4.2 HU, 19.6 ± 2.3 HU and 158.5 ± 26.0 HU for the whole pelvis, soft tissue, and bone, respectively. The peak signal-to-noise ratio was 35.2 ± 1.7 and the structural index similarity measure was 0.9758 ± 0.0035. The dosimetric difference was on average less than 1% for all PTV and OAR metrics. Plans showed good agreement with gamma pass rates of 99% and 99.9% for 1%/1 mm and 2%/2 mm, respectively. Our study demonstrates the potential of using synthetic CT images created with a multi-planar cGAN method from 0.35T MRI TrueFISP images for the MRgART treatment of prostate radiotherapy. Future work will validate the method in a large cohort of patients and investigate the limitations of the method in the adaptive workflow.

Improving Online Railway Deadlock Detection using a Partial Order Reduction

Although railway dispatching on large national networks is gradually becoming more computerized, there are still major obstacles to retrofitting (semi-)autonomous control systems. In addition to requiring extensive and detailed digitalization of infrastructure models and information systems, exact optimization for railway dispatching is computationally hard. Heuristic algorithms and manual overrides are likely to be required for semi-autonomous railway operations for the foreseeable future. In this context, being able to detect problems such as deadlocks can be a valuable part of a runtime verification system. If bound-for-deadlock situations are correctly recognized as early as possible, human operators will have more time to better plan for recovery operations. Deadlock detection may also be useful for verification in a feedback loop with a heuristic or semi-autonomous dispatching algorithm if the dispatching algorithm cannot itself guarantee a deadlock-free plan. We describe a SAT-based planning algorithm for online detection of bound-for-deadlock situations. The algorithm exploits parallel updates of train positions and a partial order reduction technique to significantly reduce the number of state transitions (and correspondingly, the sizes of the formulas) in the SAT instances needed to prove whether a deadlock situation is bound to happen in the future. Implementation source code and benchmark instances are supplied, and a direct comparison against another recent study demonstrates significant performance gains.

A method for estimating scheduled and manual override heating behaviour and settings from measurements in low energy UK homes

PurposeThe purpose of this paper is to present a methodology for estimating scheduled and manual override heating events and heating settings from indoor air temperature and gas use measurements in UK homes.Design/methodology/approachLiving room air temperature and gas use data were measured in ten UK homes built to low energy standards. The temperature measurements are used to establish whether the central heating system is turned on or off and to estimate the heating setpoint used. The estimated heating periods are verified using the homes' average daily gas consumption profiles.FindingsUsing this method, the average number of heating periods per day was 2.2 (SD = 0.8) on weekdays and 2.7 (SD = 0.5) on weekends. The weekday mean heating duration was 8.8 h and for weekends, it was 9.8 h. Manual overrides of the settings occurred in all the dwellings and added an average of 2.4 h and 1.5 h to the heating duration on weekdays and weekends respectively. The mean estimated setpoint temperatures were 21.2 and 21.4°C on weekdays and weekends respectively.Research limitations/implicationsManual overrides of heating behaviours have only previously been assessed by questionnaire survey. This paper demonstrates an alternative method to identifying these manual override events and responds to a key gap in the current body of research that little is currently reported on the frequency and duration of manual heating overrides in UK homes.Practical implicationsThe results could be used to better inform the assumptions of space heating behaviour used in energy models in order to more accurately predict the space heating energy demands of dwellings.Originality/valueManual overrides of heating behaviours have only previously been assessed by questionnaire survey. This paper demonstrates an alternative method to identifying these manual override events and responds to a key gap in the current body of research that little is currently reported on the frequency and duration of manual heating overrides in UK homes.

Subsea valves and actuators: a review of factory acceptance testing (FAT) and recommended improvements to achieve higher reliability

Oil exploration is constantly moving into deeper waters. The costs associated with downtime and the maintenance of facilities and equipment such as valves and actuators, collectively known as Operation Expenditures (OPEX), are very high in the offshore sector of the oil and gas industry, particularly the subsea sector, where water depth may reach 1–3 km. Subsea valve and actuator failures contribute to other negative consequences such as loss of production and Health Safety and Environment (HSE) issues such as environmental pollution as a result of oil spillage. Therefore, more reliable subsea equipment, including valves and actuators, is required in the industry. The reliability of valves and actuators is largely dependent on testing, specifically factory acceptance tests (FAT) and qualification test programs. This paper reviews twelve existing tests based on international standards such as the American Petroleum Standard (API) and the International Standardization for Organization (ISO) for valves, actuators and manual gear overrides. Different types of tests such as pressure tests, function tests and operation characterization tests are included in this review. Parameters such as test pressure and duration, test preparation and methods for test implementation are discussed. Eight additional tests are proposed in this paper on the basis of industrial experience to minimize the failure rate of expensive subsea equipment and to increase its reliability.

Online Convex Optimization With Binary Constraints

We consider online optimization with binary decision variables and convex loss functions. We design a new algorithm, binary online gradient descent ( <monospace xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">bOGD</monospace> ) and bound its expected dynamic regret. We provide a regret bound that holds for any time horizon and a specialized bound for finite time horizons. First, we present the regret as the sum of the relaxed, continuous round optimum tracking error, and the rounding error of our update in which the former asymptomatically decreases with time under certain conditions. Then, we derive a finite-time bound that is sublinear in time and linear in the cumulative variation of the relaxed, continuous round optima. We apply <monospace xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">bOGD</monospace> to demand response with thermostatically controlled loads, in which binary constraints model discrete <sc xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">on/off</small> settings. We also model uncertainty and varying load availability, which depend on temperature deadbands, lockout of cooling units and manual overrides. We test the performance of <monospace xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">bOGD</monospace> in several simulations based on demand response. The simulations corroborate that the use of randomization in <monospace xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">bOGD</monospace> does not significantly degrade performance while making the problem more tractable.

Physical environmental and contextual drivers of occupants’ manual space heating override behaviour in UK residential buildings

This paper investigates the physical environmental (indoor and outdoor temperature and relative humidity, wind speed, solar radiation and rainfall) and contextual drivers (time of day) affecting occupants’ manual space heating override behaviour during the heating season based on measurements collected in ten UK dwellings. Logistic regression modelling is used to understand the probability of occupants manually overriding their scheduled heating periods. To the authors’ knowledge, these are the first stochastic models of manual heating override behaviour developed for residential buildings. The work reported in this paper suggests that occupants’ manual overrides are influenced by indoor and outdoor temperature, indoor relative humidity, and solar radiation. In addition, the effects of the physical environmental variables varied in relation to the time of day. At night, none of the physical environmental variables influenced manual overrides. In the morning, afternoon and evening, manual overrides were governed by a mix of indoor air temperature, indoor relative humidity and solar radiation. The models presented can be used in building performance simulation applications to improve the inputs for space heating behaviour in residential buildings and thus the predictions of energy use and indoor environmental conditions.

Scanning for Safety

This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.

Scanning for Safety

This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.

IT Strategies for Increased Rail Employee Satisfaction

CN (Canadian National Railway) is the largest railway in Canada and a leader in the North American rail industry. In the bids and bulletins evaluation process, 7,500 CN employees submit their job preferences as bids and are assigned jobs in a manner to ensure that all positions are filled. Each week, CN posts bulletins describing the available jobs and their requirements. On the basis of the bulletins, employees submit a bid card that identifies and ranks the jobs in which they're most interested. The bidding period runs for seven days. Forty-eight hours after the bidding period closes, job assignments are posted and become effective. A legacy software system, coded in Cobol, assigns the jobs, but regional schedulers must manage exceptions and infeasibilities. Typically, to achieve a publishable schedule, the software must be run several times, with manual overrides. Because the legacy system is slow, schedulers sometimes resort to personalized spreadsheets to assist decision making. CN is pursuing a phased implementation of SAP enterprise systems. As the company phases out legacy software, it's looking for new ways to leverage information technology to improve operations and increase employee satisfaction.

The effect of training on nurse agreement using an electronic triage system

Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training. This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted kappa) statistics. In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted kappa = 0.55; 95% confidence interval [CI] 0.49-0.62); agreement improved in phase 2 (weighted kappa = 0.65; 95% CI 0.60-0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods. Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.

Human Engineering

How should we design systetns to provide “solutions-in-the-computer” to solve “problems-in-the-factory”? Intelligent systems, while providing a value-added commodity to the factory floor, often decide on courses of action that are in conflict with the human user, leading to manual over-rides of decisions. The reason for this is that many times the human user was not incorporated as an integral component or agent of the fabric of the system. As the intelligence becomes deeper imbedded into systems. so the opportunitics for synergy between the user and the autotmata are lost and, in fact, replaced rather by a competition between the players. The solution may be to fully consider the human, as an idealized holon, as part of the system architecture and a key player in the design process.

Telemetry and Control System for Interplatform Crude Loading at the Statfjord Field

A control system for crude loading to tankers at the Statfjord field has been designed by Mobil Exploration Norway Inc. The objective of the interplatform crude tieline and control system was to allow tanker loading to take place at all times in order to prevent production shutdowns due to loading buoy problems. The control system has been designed to maximize the flexibility of loading operations and meet all safety and regulatory requirements. This paper discusses the design criteria for the crude tieline control system, and describes how these were met by utilizing fail safe telemetry equipment, hardwired permissive relay logic and programmable logic controllers (PLC's). The experience gained from more than three years of operation of the system is reviewed. The system has allowed maximum use of total field storage capacity while loading crude to 125000 DWT tankers nearly every day throughout the year. It has been possible to maintain a high production rate event through periods of difficult weather conditions as experienced in the northern North Sea.

Library Automation and Overdues

The article is intended as a guide for libraries that are considering automation and for which the overdues process is an area of concern. Manual and automated overdues procedures are compared, and special features of automated systems (sorting by ZIP code, manual overrides) are examined. Minimum requirements for thc automated handling of the overdues function are outlined. For example, such a system should be able to produce overdues notices in batch mode.

Continental Reserves and Deliverability: ABSTRACT

End_Page 976------------------------------A computer system for oil and gas reserves and deliverability developed by Florida Computer Systems Co. for Florida Gas Transmission Co. and Florida Exploration Co. (subsidiaries of Continental Resources Co.) is described. The basis of the system is a data base consisting of identification, reserve and deliverability parameters, contract data, prices, and production and purchase histories. Individual data items from the data base are retrieved and manipulated to create reports. This system was a joint project of data processing, exploration, and pipeline personnel and, as a result, it handles oil and gas information from both the buyer's and the seller's viewpoints. Major user features of the system are: (1) on-line mode of operation with interactive programming for rapid response; (2) extensive report generation capability based on parameters specified by the user; (3) graphics capability that includes a four-color CRT terminal and printer; (4) programmed data editing and error recovery; (5) manual overrides at all levels; (6) security levels determined by user's password; (7) three methods of data access: alphanumeric name, code number, or selection from a list using a light pen. Major technical aspects of the system are: (1) developed and running on IBM 370/138 under DOS/VSE; (2) on-line control by CICS; (3) data base maintained by DL-I Data Management System; (4) structured programming techniques; (5) parameter-driven logic; (6) documentation prepared with HIPO. End_of_Article - Last_Page 977------------

Experience with a Successful System for Forecasting and Inventory Control

The wealth of management-science literature dealing with optimal solutions to the inventory-control problem would be more impressive if there were not a dearth of evidence of successful applications of these tools. As a step into this gap, this paper describes experiences with an evolutionary approach to a system for the centralized control of inventories of finished products in several branch warehouses; it embodies forecasting and inventory ordering, and is characterized by a man-computer partnership. Both manual overrides of the computer-generated order parameters and exception reporting a Low significant cost savings with no degradation of service. A very simple inventory-control doctrine allowed the operating personnel to gain confidence in the system—and management science in general. Based on this confidence, a simple simulation model was developed to permit evaluating alternative simple algorithms.

APPARATUS FOR AUTOMATIC NON-REPEATING PRESENTATION OF EVENT SEQUENCES AND RECORDING OF RESPONSE CHAINS FOR SEQUENTIAL ANALYSIS.

A basic apparatus is described for programming events (discriminative stimuli, reinforcements, etc.) automatically. An indefinitely long sequence of dichotomous events can be scheduled with any distribution desired, by means of pre-punched cards. Manual overrides are provided for each automatic function of the programmer, and the state of the system and location of the program are continuously displayed. It is suggested that the unit is of most value in studies employing fixed and changing schedules of partial reinforcement, in probability learning studies, and in other situations requiring noncontingent reinforcement. Auxiliary apparatus used in studying response sequences under noncontingent reinforcement is described, and circuits for construction are specified.