THREAD: Spent the past 2 days co-designing & testing the #CovidVaccine administration process @UnityHealthTO using #simulation informed #design.

A huge multi-disciplinary effort coordinated by @Sim_StMikes. cc: @IrfanDhalla

Here's some insights into the process

1/
2/ Why does it matter? Somewhat self evident, but we want to design & test a process that optimizes the number of people who be vaccinated while also ensuring a pleasant & safe experience

Great clip from "the Founder"... example of design #simulation

3/ We began with core objectives/principles for the project.

This informed the blueprints for the design of the space

But we all know, things may look good on paper, but don't necessarily translate to real-life

More importantly, people's behavior can be difficult to predict
4/ We began with a modified "pluralistic walkthrough"
bit.ly/38n10aC - users/experts/designers step-by-step work through usability issues with dialog elements

We modified the process to enhance the user-experience, optimize safety while reducing confusion points
5/ The following day with a more finalized set of steps participants moved through the process in real time. Each step was timed to accurately establish time from registration to vaccination to exit

Rapid cycling simulation resulted in immediate changes to improve the process.
6/ These iterative changes have allowed us to rapidly modify the design of our space, add user-centered design features and increase efficiency.

We've tested multiple scenarios and potential challenges that may arise - each now has specifically designed mitigation strategies
7/ When we begin vaccination this week, we're confident our process will be both safe and efficient while taking into account the importance of the human experience.

#crushcovid

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More from @petrosoniak

29 Oct
THREAD: 5yrs ago we began the TRUST study. Excited to see it finally published in @BMJ_Qual_Saf . This kicked off my interest in using simulation to support patient safety and simulation-informed clinical design.

Here’s some thoughts & reflections

qualitysafety.bmj.com/content/early/…
2/ Study goal = identify/quantify latent safety threats during trauma ISS & analyze using framework analysis

We published other data including tracking movement within the clinical space stel.bmj.com/content/5/2/78

& debriefing content during systems sim.
stel.bmj.com/content/early/…
3/ This study was only possible with substantial support from @UnityHealthTO , our dept & @Sim_StMikes

My mentor, @HumanFact0rz taught me the importance of pitching an idea to the right people. When we started simulation for systems eval & patient safety was uncommon
Read 14 tweets
22 Oct
My take on TXA in TBI following an excellent review by @Kumait_Allawati @SameerSharifMD @Bram_Rochwerg & colleagues. disclosure I'm a co-author

Study objective? What is the efficacy & safety of TXA in acute TBI.

I'll provide my clinical interpretation & link to my practice
1/
There's been recent studies looking at this (CRASH 3) and one in the prehospital setting jamanetwork.com/journals/jama/…

This SR/MA provides a more fulsome look at the data including this brand new evidence.

2/
The results?

In pooled analysis, TXA likely has no effect on mortality or disability.

A few considerations when I try to contextualize the clinicaly relevance. Not all TBI are equal. GCS 3 =/= GCS 12. A SDH is not the same as SAH or EDH etc. So their are limitations here

3/
Read 15 tweets
2 Oct
Thread
A byproduct of the confusing #ontario govt #covid19 response is “well my kids are in school, so I can't limit my contacts, its pointless”.

This is also known as “all or nothing” cognitive distortion. Specifically, it is evaluating ones life in extremes
1/
All or nothing in reference to #covid19 behavior is "if you can’t fully socially isolate then what’s the point at all".

It's very easy to fall into this way of thinking.

psychologytoday.com/us/blog/turnin…
2/
For example, my kids go to school, so they are exposed to ~20-30 people/day. An all or nothing approach says it doesn’t matter how I socialize because I can’t achieve perfection (isolate the way public health advises) since my kids are in school.

3/
Read 6 tweets
23 Sep
Thread:
1/ There are growing calls for effective strategies to message to the public about risk and behavior change in the #COVID pandemic.

A few thoughts on influencing behavior. Image
2/ It’s worth reflecting on how we can influence behavior (nicely summarized in the book Switch)

Behavior is influenced by our
1.Emotions
2.Rational thought
3.Environment (designing path of least resistance)

medium.com/@jeffmarr/swit…
3/ Importantly, emotions and rational thought often compete… and emotions typically prevail. How do we capitalize on that? Image
Read 9 tweets
28 Aug
We need more of this type of work. Exceptional, large scale simulation that looks to observe behavior within various models of distancing and precautions.
cc: @HumanFact0rz
1/
npr.org/sections/coron…
While the conditions won't be perfectly replicated, we can't wait or expect perfection. What's more important is understanding people's behavior in these environments and how various interventions may impact (positively or negatively).

2/ Image
Too often protocols loook good on paper but then implementation results in many unintended consequences...Here's a host of examples. fs.blog/2018/02/uninte…

Simulation helps us observe & understand real world implementation then make data informed changes

3/
Read 5 tweets
17 Aug
I've read with interest the proposal by @SickKidsNews to conduct simulations about the #covid19 back to school experience. I think this is an excellent concept which wrote about about a while ago.

Here's the link to the study
safeschoolcovid19.ca
Many people have noted concerns about the validity of the study given it will be conducted in private schools (appropriate criticism) though probably worth knowing whether they tried to study in public schools and whether any road blocks.
I'm curious to hear more from the study investigators about what looks like the primary outcome of the study... which seems to be related to glow in the dark liquid transmission through out the class. This appears to overemphasize surface transmission rather than person to person
Read 6 tweets

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