Comparing Sources of Disruptions to Telemedicine-Enabled Stroke Care in an Ambulance

Objective: The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Background: Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation. Method: Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption—the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded. Results: Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard–related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions. Conclusion: Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.

Effect of Computer Keyboard Slope on Upper Limb Postures at Sitting and Standing ComputerWorkstations : A Pilot Study

A user’s posture at a computer workstation, especially wrist posture, is determined by the keyboard angle. Most commercially available computer keyboards have a built-in positive slope that requires the user to extend their wrist approximately 20° when typing. The purpose of this study is to find the negative keyboard angles that minimize wrist extension for both sitting and standing workstations. In this study, we compared upper limb working postures, including those of the wrist, elbow and shoulder, at 5 different keyboard angles between −16° and +6° in sitting and standing postures. Based on our results, we can conclude that the optimal range of keyboard slope is from −4° to −12° in sitting posture and −8° to −12° in the standing posture in terms of minimum wrist extension, typing performance, and user preference. We also propose a universal keyboard support design as an attachment to currently available keyboards.

Assessment of computer workstations for compliance with ergonomic guidelines: A field study

BACKGROUND: Computer workstation use is a risk factor for the development of musculoskeletal disorders. Governmental guidelines have been developed as a resource for workstation set-up to minimize this risk. The degree of worksite compliance with guidelines has not been examined. OBJECTIVE: The purpose of this study was to examine workstations using the VDT Workstation Checklist to determine compliance, and potential modifications. METHODS: Subjects were recruited from a variety of work settings in Erie, PA. Workstations were assessed with the worker present, using the VDT Workstation Checklist. Adjustments and recommendations were made as appropriate. RESULTS: Of the 60 workstations examined, 48%did not receive a passing score. All but one were correctable to an acceptable level with minimal low-cost modifications. The recommendation for wrist rests (43%), changes in monitor height (30%) or position (27%) and reposition of the keyboard (13.3%) and mouse (13.3%) were the most frequent modifications. Ten (16.7%) workstations did not require modification. CONCLUSIONS: Almost half of workstations reviewed were not in compliance with current guidelines, however almost all (98%) could be brought into compliance with simple modifications. Office workers need guidance in setting up workspace and adjusting ergonomic equipment to provide comfortable and safe work settings and minimize musculoskeletal symptoms.

Easing hospitalist electronic health record burden through clinical workstation single sign-on

Background: Computer workstation single sign-on (SSO) was implemented in 19 hospitals to reduce manual keyboard login and expedite access to the electronic health record (EHR) and clinical applications.Objective: To quantify hospitalists time liberated from EHR keyboard to focus on patient care, and estimate financial value of this time for hospitalists.Methods: Login duration prior to and after SSO implementation were compared in eight hospitals. Using national estimates of hospitalist hourly wage, dollar values of time liberated from keyboard were calculated, stratified by different levels of total EHR use.Results: Following SSO implementation, first of shift login decreased 5.3 seconds (15.3%), and reconnect duration decreased 20.4 seconds (69.9%). The volume of hospitalist EHR use among all physician end users comprises 70%-90% of all electronic documentation and clinical orders issued, yielding an annual range of 10,302 hours (or 858.5 12-hour shifts) to 13,245 hours (or 1,103.8 12-hour shifts) in hospitalist time liberated from keyboard for patient care, with recurrent annual value of $1,164,126 to $1,496,685.Conclusions: Hospitalists gained meaningful amounts of time for patient care from SSO implementation. This time accrued to substantial financial value. SSO eases the EHR burden of hospitalists, and facilities using hospitalists extensively should consider SSO implementation.

Association between Poor Ergophthalmologic Practices and Computer Vision Syndrome among University Administrative Staff in Ghana

Aim. The aim of this study was to assess the prevalence of computer vision syndrome (CVS) and its associated ergonomic factors among university administrative staff in Ghana. Methods. A cross-sectional survey was conducted among 200 administrative staff of the University of Cape Coast. The procedure included a self-administered questionnaire, comprehensive ocular health examination, and assessment of computer workstation and lighting conditions. The prevalence of CVS among the subjects and the association between CVS and ergonomic practices were determined. Results. The mean age of the study sample was 31.0 ± 4.7 years, and the majority were males (56.0%). The prevalence of CVS was among 103 (51.5%)participants. Over a third of the respondents used computers for 6 or more hours daily. Significant association was found between CVS and poor ergonomic practices (χ = 15.175, p=0.001). Conclusion. In addition to poor ergonomic office setup, university administrative staff spend several hours behind computer screens leading to the development of CVS. Increased awareness of CVS and adherence to recommended ergonomic practices are necessary to reduce the prevalence of CVS and ultimately enhance work satisfaction and productivity.