Physical Layout Research Articles

Medical Record Keeping for Quality Patient Care

Introduction: Effective management of medical records is essential for delivering high-quality treatment. The location, architecture, and personnel of a medical records department (MRD) can considerably impact its operational efficiency. This study seeks to examine hospital MRD and establishes whether its current configuration is suitable for effective medical record management. Materials and Methods: The descriptive method was utilized to evaluate the MRD of the hospital. The review analyzed the department's physical layout, personnel, workload, training programs, and available equipment. The study also evaluated the influence of government and business restrictions on MRDs operations. Results: It was determined that the MRD of the hospital had an appropriate physical layout, with divisions positioned in optimal locations. The department's personnel levels were adequate, with twenty employees managing the patient population's workload. The analysis determined that the department required extra photocopiers and scanners to boost operational efficiency. In addition, the study underlined the significance of adhering to policies, protocols, and established processes in ensuring efficient workflow. Conclusion: The analysis concludes that the hospital MRD has an adequate physical layout, staffing levels, and task management. However, the present equipment could be enhanced to increase operational efficiency. The study also emphasizes the importance of adhering to policies, protocols, and written processes to ensure the department's efficient workflow. The outcomes of this study may inform future decisions on MRD management in other health-care organizations, especially those subject to comparable government and commercial regulations.

Proven Impact of an Advanced Air Purification System in the Reduction of Infectious Airborne and Surface Pathogens, Concomitant Reduction of Hospital-acquired Infections and Length of Stay, and Improvement in Health-care Economics.

Proven Impact of an Advanced Air Purification System in the Reduction of Infectious Airborne and Surface Pathogens, Concomitant Reduction of Hospital-acquired Infections and Length of Stay, and Improvement in Health-care Economics.

Suitable ESL Classroom Size and Environment for Effective Learning at Tertiary Level in Bangladesh

Creating an effective learning environment in tertiary-level classrooms in Bangladesh can be challenging. The size of the classroom and the atmosphere within it can have a significant impact on the learning experience and outcomes of students. Classroom size is an important factor to consider when creating a space conducive to learning. The study sights on the consequence of ESL (English as Second Language) classroom size and environment at the tertiary level in Bangladesh. The study is qualitative in nature. It is consisted of a review of the extensive literature in the respective field, interviews with twenty English teachers from two renowned private universities in Bangladesh, and the observation of twenty classrooms from those universities. It has been found from the cross-checking of teachers’ interviews and classroom observation that most of the universities do not have suitable classroom size as well as the environment negatively impacted on ESL learners. A classroom that is too small or too large can make it difficult for students to learn effectively. Ideally, class size should be between 25-30 students for optimal learning outcomes. Besides, larger class sizes may require additional materials and resources to ensure that each student has access to the necessary materials. Furthermore, the classroom must be well-lit and ventilated so as to create a comfortable environment for learning. Finally, it is important for teachers to consider the physical layout of the classroom and ensure that it facilitates an atmosphere conducive to effective instruction. By taking these considerations into account, teachers are able to create an environment where students are able to learn effectively and reach their full potential.

The Standard Operating Procedures in COVID-19 Pandemic for Periodontal Aerosol-Generating Procedures: A Process Audit.

This study aims to audit the process of patient management with aerosol-generating procedure (ultrasonic scaling) while adherence to the guidelines for health care workers (HCWs) during the coronavirus disease 2019 (COVID-19). Audits records at the Department of Periodontology at University College of Medicine and Dentistry Hospital, Lahore, Pakistan were collected (prospectively) over the period of October 1 to November 30, 2020 (1st cycle) and December 14, 2020 to February 12, 2021 (2nd cycle). The audit was divided into three components based on the guidelines: (1) physical environment, (2) patients/appointments, and (3) COVID standard operating procedures related to HCWs. The recommended physical layout and procedural factors, as suggested by the guidelines for dental clinics, were observed during the first cycle of audit, and discrepancy of ventilation system was fixed after the first cycle. Audit team reported the observance of fallow time three times daily, which revealed 83.3% observance of fallow time.Later in the second cycle when the extraoral high-volume air evacuator was installed, the fallow time was reduced to 15 minutes and not only five procedural slots per day were created but fallow time was also observed 100% of the time. Following the standard guidelines resulted in more efficient working environment and lesser risk for HCWs while performing aerosol-generating procedures.

Differentiable Constraints’ Encoding for Gradient-Based Analog Integrated Circuit Placement Optimization

Analog IC design is characterized by non-systematic re-design iterations, often requiring partial or complete layout re-design. The layout task usually starts with device placement, where the several performance figures and constraints to be met escalate its complexity immensely, and, due to the inherent tradeoffs, an “optimal” floorplan solution does not usually exist. Deep learning models are now establishing for the automation of the placement task of analog integrated circuit layout design, promising to bypass the limitations of existing approaches based on: time-consuming optimization processes with several constraints; or placement retargeting from legacy designs/templates, which rely heavily on legacy layout data. However, as the complexity of analog design cases tackled by these methodologies increases, a broader set of topological constraints must be supported to cover the different layout styles and circuit classes. Here, model-independent differentiable encodings for regularity, boundary, proximity, and symmetry island constraints are formulated for the first time in the literature, and an unsupervised loss function is used for the artificial neural network model to learn how to generate placements that follow them. The use of a deep learning model makes push-button speed placement generation possible, additionally, as only sizing data are required for its training, it discards the need to acquire legacy layouts containing insights into this vast set of, often neglected, constraints. The model is ultimately used to produce floorplans from scratch at push-button speed for real state-of-the-art analog structures, including technology nodes not used for training. A case-study comparison with a floorplan design made by a human-expert presents improvements in the fulfillment of every constraint, reaching an overall improvement of around 70%, demonstrating the approach’s value in placement design.

Design of a cryogen-free high field dual EPR and DNP probe

We present the design and construction of a cryogen free, dual electron paramagnetic resonance (EPR) and nuclear magnetic resonance (NMR) probe for novel dynamic nuclear polarization (DNP) experiments and concurrent “in situ” analysis of DNP mechanisms. We focus on the probe design that meets the balance between EPR, NMR, and low temperature performance, while maintaining a high degree of versatility: allowing multi-nuclear NMR detection as well as broadband DNP/EPR excitation/detection. To accomplish high NMR/EPR performance, we implement a novel inductively coupled double resonance NMR circuit (1H-13C) in a solid state probe operating at cryogenic temperatures. The components of the circuit were custom built to provide maximum NMR performance, and the physical layout of this circuit was numerically optimized via magnetic field simulations to allow maximum microwave transmission to the sample for optimal EPR performance. Furthermore this probe is based around a cryogen free gas exchange cryostat and has been designed to allow unlimited experiment times down to 8.5 Kelvin with minimal cost. The affordability of EPR/DNP experiment is an extremely important aspect for broader impact with magnetic resonance measurements. The purpose of this article is to provide as complete information as we have available for others with interest in building a dual DNP/EPR instrument based around a cryogen-free cryostat.

Optimizing bend loss in optical waveguide channel routing on photonic integrated circuits

Silicon photonics (Si-photonics) has been established as a potential technology that integrates both electronic and optical circuits on single integrated circuits (ICs) in order to satisfy the increasing demand for high speed and low power in the emerging market of ICs. It has opened up the research directions in the domain of design automation for photonic ICs. On the physical layout of the optical circuits, it is a challenging task to obtain the optimal routing of optical waveguides, while minimizing all the parameters like the number of tracks, total bend loss, worst signal loss, total propagation loss and total crossing loss. In this paper, we proposed two non-Manhattan grid-based methods for reducing the bend loss, worst signal loss and tracks in optical channel routing. First, a 0–1 integer linear programming-based algorithm called minimizing bend loss (MBL) is proposed, which minimizes the total bend loss (TBL) and the worst signal loss (WSL) while reducing the number of tracks (T) over the state-of-the-art technique. The execution time of MBL is very high for the large input. Hence next, a scalable heuristic called reducing bend loss (RBL) is presented that provides a better balance between the reduction of the TBL and T over the state-of-the-art and MBL algorithms. Simulation results show that MBL can reduce the TBL and the WSL by an average of 57.9% and 63.1%, respectively, with an average increase of 12% in T over state-of-the-art algorithms. The simulation results show that the RBL reduces the TBL and the WSL by an average of 39.7% and 41.3%, respectively, with an average increase of 23.7% in T over state-of-the-art algorithms.

Crosstalk-Aware Automatic Topology Customization and Optimization for Wavelength-Routed Optical NoCs

Optical network-on-chip (ONoC) is an emerging upgrade for electronic network-on-chip (ENoC). As a kind of ONoC, wavelength-routed ONoC (WRONoC) shows ultrahigh bandwidth and ultralow latency in data communication. Manually designed WRONoC topologies typically reserve all to all links. This causes the waste of resources. Topology customization for each individual communication network can save resources, but requires automation for efficient design. The state-of-the-art design automation method is not efficient and does not support crosstalk analysis and signal-to-noise ratio (SNR) optimization. Moreover, the state of the art does not consider the physical locations of the data sending/receiving ports, causing unavoidable detours and crossings in the physical layout. In this work, we present FAST+: an automatic topology customization and optimization method. Compared with the state of the art, FAST+ operates much more efficiently and proposes a concrete router-level crosstalk-analysis method and a novel SNR optimization algorithm. This work also provides solutions to avoid detours and crossings in the physical layout. When SNR optimization is not enabled, experimental results show that FAST+ runs thousands times faster than the state of the art on average while providing multiple better or equally good topologies regarding resource usage and the worst case insertion loss. When SNR optimization is enabled, FAST+ provides <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$1.75\times $ </tex-math></inline-formula> better worst case SNR on average after the optimization while not sacrificing resource usage and the worst case insertion loss.

Perceptions of People Living With Moderate to Severe Traumatic Brain Injury About Grocery Shopping Performance

<h3>Research Objectives</h3> To investigate the impact of brain injury (TBI) on grocery shopping performance from the viewpoint of those who have suffered a moderate or severe TBI. <h3>Design</h3> Exploratory and descriptive qualitative approach. <h3>Setting</h3> Specialised acquired brain injury rehabilitation service (inpatient and community rehabilitation services). <h3>Participants</h3> Maximum variation purposive sampling was used to recruit 14 adults with moderate to severe TBI. A total of 8 people were recruited from the inpatient rehabilitation ward, while 6 were community dwelling. All participants had participated in rehabilitation which addressed grocery shopping. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Semi-structured interviews ranging from 20-60 minutes were conducted. Data were analysed using a thematic approach, with deductive coding to the American Occupational Therapy Practice Framework. Demographic data (age, time post injury, living situation, severity of injury) were gathered from the medical record and the Functional Independence Measure (FIM™) was completed on all participants. Double coding of >10% of interviews was completed to increase rigor. <h3>Results</h3> Five key themes emerged from the data; getting to the shops, generation and use of a list, searching and locating items, selecting items, budgeting and paying for items. Brain injury related impairments (cognitive and visual) and external factors (social environment, physical environment, and restrictions on driving and financial management) were identified as being the most common factors which impacted on grocery shopping from the perspectives of those living with TBI. The physical layout and familiarity with the grocery store environment was seen to directly impact on the associated cognitive demands and grocery shopping performance. <h3>Conclusions</h3> People with TBI perceive grocery shopping as a highly contextualised multi-step activity which is impacted by cognitive and visual impairments. Clinical rehabilitation should include consideration of the multiple demands and environmental context of grocery shopping to inform targeted rehabilitation interventions for this population. <h3>Author(s) Disclosures</h3> None

Development of a high-power pulse-forming network Marx generator with a long pulse duration.

To meet the application needs for producing long-pulse electron beams and high-power microwaves, a pulse-forming network Marx generator with a pulse duration of 260ns is presented in this paper. This generator is composed of 20 stages of pulse-forming network modules. Each module is formed with nine capacitors connected in parallel. The generator functions at 44kV, which is lower than the rated voltage of the mica paper capacitor, to improve the lifetime. The impedance of the generator is designed to reach 45Ω. To avoid the strong coupling between the adjacent stages, the physical layout of the generator adopts a zigzag design. The generator is housed in a gas pressurized vessel of 600mm in diameter and 580mm in length. Across a 50Ω load, it can deliver quasi-rectangular pulses with a pulse duration of 260ns and an amplitude of 500kV for a single shot. The output pulse features a plateau duration of 160ns and a leading edge of 45ns. In burst mode, it can steadily output ten pulses of 450kV at a repetition rate of 10Hz on either a resistive load or a diode.

Doors and walls: physical barriers and knowledge sharing

ABSTRACT The extant literature has demonstrated that physical distance negatively affects knowledge sharing, even within the same building. Moreover, the impact of physical barriers, such as doors and walls, has been flagged as an important avenue for research. We contribute to the micro-geography literature by unpacking the effects of physical barriers on knowledge sharing and moderators of that relationship. Based on micro-level, single-firm observational data on employees’ knowledge-sharing dyads, we find that physical barriers impede knowledge sharing after accounting for distance. Simultaneously, we theorise on and find evidence of several moderators of the negative relationship between physical barriers and knowledge sharing at the dyadic and individual levels: strong ties, participation in coordination mechanisms across departments, job autonomy, and location in an office near a printer room. The study has implications for managers in charge of office allocation and the physical layout of offices.

A Randomized Control Study to Evaluate the Efficacy of Safe Home Toolkit for Under-Five Children (SHT-UFC) on the Awareness of Parents Regarding the Prevention of Domestic Accidents.

Background Domestic accidents among under-five children are linked to numerous factors, includingchild development, the physical layout and facilities at home, knowledgeand practices, the behavior of parents and other family members, parents' education, overcrowding and homelessness, and the availability of safety equipment in the home. Objective The objective of this study is to evaluate the efficacy of a safe home toolkit for under-five children (SHT-UFC) on parents' awareness regarding preventing domestic accidents among under-five children, to assess the baseline knowledge and practices regarding preventing domestic accidents among parents of under-five children in the control and experimental groups, to find out the reported incidence of domestic accidents among parents of under-five children in the control and experimental groups, and to evaluate the effectiveness of a safe home toolkit among parents of under-five children. Method Simple random sampling was done in each community to recruit the participants. The sampling frame (list) of the participants was collected from the Anganwadi workers of the community. Each participant was then selected by using the computer-generated table in both groups that are the experimental and control groups. Result Knowledge and practice scores regarding SHT-UFC are positively related in the pretest and post-test, indicating that knowledge influences practices. In the pretest, Pearson's correlation coefficient (r) is higherthan in the post-test because the knowledge was lessand so were the practices in the pretest. In the post-test, the knowledge gained is varied yet significant, and the practices also improved. Conclusion This study revealed that a safe home toolkit for under-five children (SHT-UFC) is effective in creating awareness among parents regarding the prevention of domestic accidents.

Crime in the nineteenth-century Irish home

ABSTRACT This article interrogates the Irish home as the scene of a crime. Using a sample of nineteenth-century textual records, namely coroners’ inquest documents, police and witness statements, judges’ reports of trials, and newspapers, it showcases how the home could become a focus of attention in court. Police (and sometimes the general public) infiltrated these domestic spaces in their search for clues; they often interfered with domestic materiality, or confiscated objects or fragments therefrom. In court, maps, plans and models illustrated the physical space and layout of the home for those who had not crossed the threshold. Witness testimonies accounting for the crime inadvertently reveal how the homes looked, some of their contents, and the nature of relationships between occupants and neighbours. These Irish homes were typically ordinary domestic spaces but as this article shows, the crime brought the intimate space to a more public arena. It also demonstrates how the home could both protect or expose a suspect.

Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study.

Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making.

Thermal prediction for Air-cooled data center using data Driven-based model

The optimal cooling control of data centers (DCs) relies on the thermal model to simulate and accurately evaluate the temperature distribution of the computer room. Data-driven thermal modeling methods have been widely used in the thermal management of DCs. However, few existing works have comprehensively compared and analyzed the predictive performance and adaptability of various data-driven thermal models. In addition, most of the proposed thermal models are for temperature prediction in steady-state scenarios of DCs, ignoring the study of thermal changes in transient scenarios. Therefore, this work builds a CFD model of a typical data center as a verification platform to compare the temperature prediction performance of six machine learning (ML)-based thermal models (SVR, GPR, XGBoost, LightGBM, ANN, LSTM) in steady-state and transient-state scenarios. For steady-state scenarios, we also explore the impact of sample size, physical layout reconfiguration, and airflow pattern on performance to evaluate the adaptability of the thermal model. For transient scenarios, we design four cooling failure scenarios to verify the ability of the proposed thermal model to capture the dynamic thermal changes of the computer room. Numerous numerical simulation results show that the XGBoost-based and LightGBM-based thermal models outperform other ML models in both steady-state and transient-state scenarios, with prediction error RMSE is less than 1.0 ℃, and the time overhead is less than 10-3 s. In addition, both thermal models are robust to physical layout reconfiguration and poor flow patterns.

Planning and Architecture as Determining Influences on the Housing Market: Budapest–Csepel’s Post–War Housing Estates

In Hungary, post-war housing estates can be categorised according to the time of their construction. Thanks to the development of construction technologies and urban planning, these so-called generations of housing estates demonstrate different features with regard to their physical layout and socio-economic characteristics. Socio-economic transformation that took place after the change of regime (1989) was widely affected by the physical parameters of these neighbourhoods and their dwelling stock. Our results show that different generations of housing estates have followed distinct trajectories in the housing market; thus, in addition to their geographical location within the city, planning, architecture, design, and the dwelling stock play a significant role in the market positions of these generations of housing estates. House prices have risen rapidly in Budapest since 2014 up until the pandemic in 2020, and housing estates became popular segments of the housing market. The main aim of this article is to investigate the role of urban planning, architecture and the built environment in this real estate process. The research is based on empirical real estate investigations, statistical house price analyses, and fieldwork undertaken on housing estates. The case study area is Csepel, a former industrial town which became the administrative district 21 of Budapest in 1950. All types of post-war generations of housing estates co-exist, and the majority of the population lives in such neighbourhoods. This special geographical context makes it possible to explore the influential role of the built environment in the housing market. Empirical results from these low- and mid-rise housing estates can make a major contribution to the more effective and successful development of high-rise neighbourhoods.

Understanding successful transition to independent living: A qualitative study of young adults with disabilities

BackgroundIndependent Living (IL) involves having choice and control over where and with whom one lives. People with disabilities are less likely to live independently than their peers without disabilities. ObjectiveThe purpose of this study was to understand the perceptions of young adults with mobility disabilities regarding IL, how they define IL, and what advice they would give others considering living a more independent life. MethodSemi-structured interviews were conducted with six young adults with mobility disabilities who had successfully transitioned to living independently. A content analysis was used to identify emergent themes from the interviews. ResultsResults indicate that participants had individualized perceptions of the definition of IL. Participants identified many barriers and facilitators to IL, including the physical layout of housing, available amenities, and social support. They recommended preparing for IL in advance and taking advantage of outside resources to enable a successful transition. ConclusionYoung adults with mobility disabilities define IL in various ways, which may have an impact on whether they consider their transition to IL successful. Findings can be used to guide recommendations for young people with disabilities to use to ensure a successful transition to IL.

Policy Analysis for Prevention and Control of Influenza in Aged Care.

This study aimed to analyze national influenza infection control policy documents within aged care settings by identifying the consistencies, inconsistencies, and gaps with the current evidence and by evaluating methodological quality. Aged care providers can use these findings to identify their policy documents' strengths and weaknesses. A quality and content analysis of national level policy documents. Aged care settings rely on national agencies' policy recommendations to control and prevent outbreaks. There is limited research on the effectiveness of control measures to prevent and treat influenza within aged care settings. Because of the complexities around aged care governance, the primary responsibility in developing a comprehensive facility-level, infection-prevention policy, falls to the providers. The analysis was conducted using the (1) International Appraisal of Guidelines, Research and Evaluation assessment tool, containing 23 items across 6 domains; and the (2) Influenza Related Control Measures in Aged Care settings checklist, developed by the authors, with 82 recommendations covering: medical interventions, nonmedical interventions, and physical layout. There were 19 documents from 9 different high-income countries, with a moderately high methodological quality in general. The quality assessment's average score was 40.2% (95% CI 31.9%-44.7%). "Stakeholder involvement" ranked third, and "Editorial independence" and "Rigor of development" had the lowest average scores across all domains. The content analysis' average score was 37.2% (95% CI 10.5%-21.5%). The highest scoring document (59.1%) included term definitions, cited evidence for recommendations, and clear measurable instructions. "Physical Layout" had the least coverage and averaged 21.9% (95% CI 4.2%-37.5%), which shows a substantial gap in built environment recommendations. Existing policy documents vary in their comprehensiveness. The higher scoring documents provide an ideal model for providers. The checklist tools can be used to assess and enhance documents. Further research on document end-user evaluation would be useful, as there is room for improvement in methodological quality and coverage of recommendation coverage, especially related to physical layout.

A Longitudinal Study of a Multifaceted Intervention to Reduce Newborn Falls While Preserving Rooming-In on a Mother-Baby Unit

Newborn falls occur when newborns held by caregivers slip from hands or arms and land on another surface. Though injury is rare, The Joint Commission has highlighted newborn falls as a patient safety priority. One hospital sought to reduce newborn falls to fewer than 10 per 10,000 births, to achieve 365 days without a fall, and to reduce injuries from falls to zero, while preserving mother-baby rooming-in. An interprofessional quality improvement team developed and implemented prevention measures after three falls occurred in a two-month period. The team performed root cause analysis (RCA) of events and 10 in-depth chart reviews, and developed and implemented parent education materials, a nursing risk assessment tool and job aid, and a standardized reporting system. Outcomes were measured using statistical process control methods for rare events. In early 2017 the hospital's newborn fall rate increased to 71.8 falls per 10,000 births, with 3 falls occurring in a two-month period. RCA and chart review found sustained prenatal maternal opioid intake in 4 of 10 cases. Mechanism of fall differed by mode of delivery, with more drops by a sleeping caregiver following vaginal deliveries and falls due to maternal trips after cesarean deliveries. After interventions, the fall rate decreased to 15.5 per 10,000 births. Days between falls increased from a low of 9 days to a high of 467 days. No newborn injuries have occurred since early 2017. A series of interventions, including parent education, nursing practices, and attention to physical layout, was associated with reduced newborn falls and elimination of fall-related injuries while preserving rooming-in on a mother-baby unit with many opioid-exposed newborns.

Frequency of Device-Related Interruptions Using a Scalable Assessment Tool.

Surgical devices are implicated in approximately 15% of intraoperative interruptions and 25% of errors. Device-related interruptions (DRIs) are therefore an important target for surgical quality improvement, but scalable measurement methodologies are lacking. The researchers therefore developed, pilot tested, and refined a simple tool for assessing intraoperative DRIs. Five DRI categories achieved face validity with frontline providers and surgical safety experts: improper/challenging assembly, device failure, loss of sterility, disconnection, and absent/wrong device. A data collection tool was created based on these categories as well as a free-text section to capture emergent DRI categories. After a brief training session, the tool was pilot tested by observers at a large academic referral center. In a sample of 210 operations, observers noted 66 DRIs across 39 cases. DRIs were most common in colorectal (38.0 per 100 cases), gynecologic (33.3 per 100 cases), and hepatopancreatobiliary surgery (32.1 per 100 cases). Device failure accounted for 30.3% of observed DRIs. Three emergent categories were identified: user unfamiliarity with the device (15.2%), video display malfunction (4.5%), and physical breakage of the device (1.5%). Measurement of DRIs by novice observers is a feasible and scalable approach to support quality improvement efforts focusing on surgical devices. This approach could provide actionable insights to improve device safety, such as informing educational and training programs, optimizing surgical tray composition, and improving the physical layout of the operating room.