Identifying built environment hazards through HFE analyses of in-situ simulations

In-situ simulations of work in health settings have been adopted to proactively identify hazards and manage risks related to the built environment (BE). In particular, video-recorded simulations allow repeated reviews and debriefings of scenarios by clinical and human factors and ergonomics (HFE) professionals. This study evaluated BE hazards influencing clinical performance and patient outcomes based on video in-situ simulation of emergency scenarios before BE occupation. Four retrospective in-situ simulation videos (approximately 10 minutes each) regarding two emergency scenarios (i.e., ventricular fibrillation and acute myocardial infarction) in a hitherto new environment of resuscitation bay of an Emergency Department (ED) in Australia were analysed according to the Hazard Assessment Remediation Tool (HART) and Functional Resonance Analysis Method (FRAM). Simulation videos were analysed by independent HFE researchers. Each 10-second video fragment was associated with FRAM functions (i.e., tasks performed), aspects (e.g., input, output, preconditions), agents and variabilities of FRAM outputs to identify latent and active hazards according to the HART categories (i.e., slip/trip/fall/injury risk; impaired access to patient or equipment; obstructed path; poor visibility; and infection risk). FRAM models of each emergency scenario were developed according to the simulation videos and feedback from current staff. HART categories were useful in identifying latent and active hazards, translated into potential and actual variabilities of the FRAM function outputs that arise from the suboptimal BE conditions.Recommendations to the ED BE were linked to the precondition aspects of FRAM functions as a strategy to mitigate the output variabilities. Methodological contributions on using HFE methods to analyse video simulations and identify BE implications were discussed. Moreover, this study highlighted recommendations for ED workflows and design. Findings will be presented at the conference to guide insightful discussions on how in-situ and video-recorded simulations of clinical scenarios have gained attention in healthcare HFE practice and the implications for BE design.