Professor Barrett Caldwell | Developing Effective Chronic Care for Patients with Traumatic Brain Injury
About this episode
An estimated 69 million people worldwide are currently living with traumatic brain injury. Now recognised as a chronic condition, traumatic brain injury can lead to sleep disorders, depression, headaches and an increased risk of suicide. Unfortunately, the human factors involved in recovery remain understudied. Working to address this is Professor Barrett Caldwell, who leads the GROUPER Laboratory at Purdue University. He and his colleagues study the processes and technologies used to manage chronic conditions, to improve care systems for people living with traumatic brain injury. Read More
In 2017, Professor Caldwell’s team explored existing chronic care systems for cancer and diabetes patients, to see if certain elements of these systems could be applied to patients with traumatic brain injury. Chronic care systems include healthcare processes, communication, decision support, information technology systems and self-management support.
The team found that existing diabetes care systems can provide substantial insight into improving chronic care for patients with traumatic brain injury. Studying cancer care systems also provided insight into the long-term psychosocial requirements of brain injury patients.
Human errors that occur while following procedures can harm patient health. Therefore, minimising the chances of human error is extremely important in healthcare systems. Professor Caldwell’s group conducted interviews to better understand the possible sources of human error when providing chronic care to brain injury patients.
The researchers discovered that handoff events, such as the transfer of information between different clinics or work shifts, are a significant source of human error. They found that certain forms of communication, such as scanning and printing medical records, often result in the incomplete transfer of information.
The researchers also observed that particular types of information are more likely to be lost at certain handoff points. For example, one health professional may fail to include brain imaging records when preparing a patient report for another health professional. Professor Caldwell suggests that such handoff processes be investigated, in order to design a system that minimises information misalignment or mismanagement.
In a related study, Professor Caldwell’s team further explored sources of human error when workers follow critical mission procedures. They not only focused ‘operator compliance’, which describes the degree to which someone obeys the guidelines, but they also investigated the quality, accuracy and overall outcome of the procedure itself, as well as how easy the procedure is to follow.
When considering the context of a chronic care system, the researchers suggest that the overall outcome of a procedure is more important than an operator’s level of compliance. For example, it is possible that appropriate non-compliance can lead to positive outcomes, while inappropriate compliance can sometimes lead to negative outcomes.
With this understanding, Professor Caldwell and his colleagues provide a broader framework that focuses on performance instead of solely focusing on compliance.
By using the team’s insights, a new chronic care system for traumatic brain injury can be designed – one that helps to reduce human error while allowing each patient to have a unique and successful rehabilitation process.
Original Article Reference
Summary of the papers: ‘Considerations for developing chronic care system for traumatic brain injury based on comparisons of cancer survivorship and diabetes management care’, doi.org/10.1080/00140139.2017.1349932; ‘Evaluating and designing procedures in safety critical environments: a framework and taxonomy based on a critical review and synthesis’, doi.org/10.1080/1463922X.2018.1529205; and ‘Multi-level, multi-discipline, and temporally-diverse handoffs in traumatic brain injury rehabilitation’, doi.org/10.1177%2F2327857918071042
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