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Don’t let complexity get in the way of safety in healthcare. That is the “simple” goal of a new coalition—spearheaded by the AAMI Foundation—that is tackling the challenge of the burgeoning development and use of complex healthcare technology. Over the next two years, the aptly named National Coalition to Promote the Safe Use of Complex Healthcare Technology aims to build a body of best practices to guide healthcare facilities and clinicians in their procurement, use, and training of technology.

These efforts kicked off in an April 12–13 meeting in Annapolis, MD. The considerations around improving the safety of complex healthcare technology are themselves complex. Addressing them will have far-reaching implication that stretch from the hospital to the patient’s home setting, and ultimately to industry, which designs the devices. That’s important because when clinicians don’t understand the intricacies of the device that they’re using, or the device is difficult to use, what results is too often an error by omission.

“Patients are still at risk of getting hurt in hospitals because of shortcomings in properly preparing clinicians to utilize complex technology in the patient care setting,” said Jim Piepenbrink, deputy executive director of the AAMI Foundation. “Clinicians are inundated with technology with the intent of improving patient care and for providing better clinical information to manage the care of the patient. Through our collaboration with industry and clinical leaders, we have found that there are limitations in most training programs because of the lack of time afforded clinicians. Too often, they’re left to figure things out on their own, or they receive training secondhand from someone else. The full breadth of what they need to know is not covered.”

The first meeting of the coalition brought together a diverse group of the coalition’s approximately 100 members, including nurses, physicians, human factors engineers, and industry representatives. Participants cited a lack of investment in training and competency assessment—particularly in hospitals with resource constraints—as well as the need for manufacturers to design complex devices that are nonetheless intuitive to use.

Coalition members will work to define what exactly constitutes a “complex” technology, a key consideration. The definition can cover technology that can be difficult to navigate because it contains many software levels, such as a mechanical ventilator. But it can also include technologically advanced equipment that is simple to use, but can be misused in a high risk, high stress situation, such as a defibrillator.

“When machines do so much, there are plusses and minuses. It can be challenging to be in full control when using this equipment. More and more equipment is being introduced,” said presenter Pete Doyle, a human factors engineer at The Johns Hopkins Hospital in Baltimore, MD. “More and more features are being added. They become more complex and less intuitive. Clinicians rarely, if ever, have the opportunity to read the manual,” which can be as long as hundreds of pages.

While a deluge of new devices can overwhelm an already strained training and education infrastructure for clinicians, they are also struggling with designs that are complex for the opposite reason. Many devices (such as pagers) are hopelessly out of date and unintuitive.

Divided into working groups, coalition members will collaborate on specific topics during the first two-year phase of the initiative. The topics they will cover include:

  • Developing best practices for selecting and purchasing complex technology
  • Guiding hospitals on where to focus their education and training efforts
  • Establishing minimal levels of proficiency and ways to assess that proficiency
  • Building the business case for hospitals to allocate financial resources to improve preparation by clinicians when using complex technology
  • Developing ongoing discussions with manufacturers regarding what the design and development of products may look like and how they will affect end users

“Through this new coalition, the AAMI Foundation and its partners want to tackle this challenge on the technology side, to see what we can do to better prepare clinicians and discuss what the healthcare industry should be doing overall to mitigate these risks,” Piepenbrink said.

The coalition will reconvene in 2019 to discuss its progress and formulate its next phase. More information on the AAMI Foundation’s patient safety initiatives is available at www.aami.org/foundation.