PDF(Pubmed)
Abstract：
BACKGROUND: Health care professionals receive little training on the digital technologies that their patients rely on. Consequently, practitioners may face significant barriers when providing care to patients experiencing digitally mediated harms (eg, medical device failures and cybersecurity exploits). Here, we explore the impact of technological failures in clinical terms.
OBJECTIVE: Our study explored the key challenges faced by frontline health care workers during digital events, identified gaps in clinical training and guidance, and proposes a set of recommendations for improving digital clinical practice.
METHODS: A qualitative study involving a 1-day workshop of 52 participants, internationally attended, with multistakeholder participation. Participants engaged in table-top exercises and group discussions focused on medical scenarios complicated by technology (eg, malfunctioning ventilators and malicious hacks on health care apps). Extensive notes from 5 scribes were retrospectively analyzed and a thematic analysis was performed to extract and synthesize data.
RESULTS: Clinicians reported novel forms of harm related to technology (eg, geofencing in domestic violence and errors related to interconnected fetal monitoring systems) and barriers impeding adverse event reporting (eg, time constraints and postmortem device disposal). Challenges to providing effective patient care included a lack of clinical suspicion of device failures, unfamiliarity with equipment, and an absence of digitally tailored clinical protocols. Participants agreed that cyberattacks should be classified as major incidents, with the repurposing of existing crisis resources. Treatment of patients was determined by the role technology played in clinical management, such that those reliant on potentially compromised laboratory or radiological facilities were prioritized.
CONCLUSIONS: Here, we have framed digital events through a clinical lens, described in terms of their end-point impact on the patient. In doing so, we have developed a series of recommendations for ensuring responses to digital events are tailored to clinical needs and center patient care.
OBJECTIVE: Our study explored the key challenges faced by frontline health care workers during digital events, identified gaps in clinical training and guidance, and proposes a set of recommendations for improving digital clinical practice.
METHODS: A qualitative study involving a 1-day workshop of 52 participants, internationally attended, with multistakeholder participation. Participants engaged in table-top exercises and group discussions focused on medical scenarios complicated by technology (eg, malfunctioning ventilators and malicious hacks on health care apps). Extensive notes from 5 scribes were retrospectively analyzed and a thematic analysis was performed to extract and synthesize data.
RESULTS: Clinicians reported novel forms of harm related to technology (eg, geofencing in domestic violence and errors related to interconnected fetal monitoring systems) and barriers impeding adverse event reporting (eg, time constraints and postmortem device disposal). Challenges to providing effective patient care included a lack of clinical suspicion of device failures, unfamiliarity with equipment, and an absence of digitally tailored clinical protocols. Participants agreed that cyberattacks should be classified as major incidents, with the repurposing of existing crisis resources. Treatment of patients was determined by the role technology played in clinical management, such that those reliant on potentially compromised laboratory or radiological facilities were prioritized.
CONCLUSIONS: Here, we have framed digital events through a clinical lens, described in terms of their end-point impact on the patient. In doing so, we have developed a series of recommendations for ensuring responses to digital events are tailored to clinical needs and center patient care.
摘要：
背景：医疗保健专业人员很少接受患者所依赖的数字技术培训。因此,从业者在为经历数字介导的伤害的患者提供护理时可能面临重大障碍(例如，医疗设备故障和网络安全利用)。这里,我们探讨了技术失败对临床的影响。
目的：我们的研究探讨了一线医护人员在数字事件中面临的主要挑战，发现临床培训和指导方面的差距，并提出了一套改进数字临床实践的建议。
方法：一项包括52名参与者的为期1天的研讨会的定性研究，国际出席,多方利益相关者的参与。参与桌面练习和小组讨论的参与者专注于技术复杂的医疗场景(例如，呼吸机故障和医疗保健应用程序上的恶意黑客攻击)。对5位抄写员的大量注释进行了回顾性分析，并进行了主题分析以提取和综合数据。
结果：临床医生报告了与技术相关的新型伤害形式（例如，家庭暴力中的地理围栏和与相互关联的胎儿监测系统相关的错误)和阻碍不良事件报告的障碍(例如，时间限制和死后设备处置)。提供有效患者护理的挑战包括缺乏对设备故障的临床怀疑，不熟悉设备，缺乏数字定制的临床方案。与会者一致认为，网络攻击应被归类为重大事件，重新利用现有的危机资源。患者的治疗取决于技术在临床管理中的作用，因此，那些依赖可能受损的实验室或放射设施的优先考虑。
结论：这里，我们通过临床镜头构建了数字事件，描述了它们对患者的终点影响。在这样做的时候，我们制定了一系列建议,以确保对数字事件的反应符合临床需求和中心患者护理.
目的：我们的研究探讨了一线医护人员在数字事件中面临的主要挑战，发现临床培训和指导方面的差距，并提出了一套改进数字临床实践的建议。
方法：一项包括52名参与者的为期1天的研讨会的定性研究，国际出席,多方利益相关者的参与。参与桌面练习和小组讨论的参与者专注于技术复杂的医疗场景(例如，呼吸机故障和医疗保健应用程序上的恶意黑客攻击)。对5位抄写员的大量注释进行了回顾性分析，并进行了主题分析以提取和综合数据。
结果：临床医生报告了与技术相关的新型伤害形式（例如，家庭暴力中的地理围栏和与相互关联的胎儿监测系统相关的错误)和阻碍不良事件报告的障碍(例如，时间限制和死后设备处置)。提供有效患者护理的挑战包括缺乏对设备故障的临床怀疑，不熟悉设备，缺乏数字定制的临床方案。与会者一致认为，网络攻击应被归类为重大事件，重新利用现有的危机资源。患者的治疗取决于技术在临床管理中的作用，因此，那些依赖可能受损的实验室或放射设施的优先考虑。
结论：这里，我们通过临床镜头构建了数字事件，描述了它们对患者的终点影响。在这样做的时候，我们制定了一系列建议,以确保对数字事件的反应符合临床需求和中心患者护理.
