title: Color-coding and human factors engineering to improve patient safety characteristics of paper-based emergency department clinical documentation.
abstract: OBJECTIVE
  Investigators studied an emergency department (ED) physical chart system and identified inconsistent, small font labeling; a single-color scheme; and an absence of human factors engineering (HFE) cues. A case study and description of the methodology with which surrogate measures of chart-related patient safety were studied and subsequently used to reduce latent hazards are presented.
  
  
  BACKGROUND
  Medical records present a challenge to patient safety in EDs. Application of HFE can improve specific aspects of existing medical chart organization systems as they pertain to patient safety in acute care environments.
  
  
  METHODS
  During 10 random audits over 5 consecutive days (573 data points), 56 (9.8%) chart binders (range 0.0-23%) were found to be either misplaced or improperly positioned relative to other chart binders; 12 (21%) were in the critical care area. HFE principles were applied to develop an experimental chart binder system with alternating color-based chart groupings, simple and prominent identifiers, and embedded visual cues.
  
  
  RESULTS
  Post-intervention audits revealed significant reductions in chart binder location problems overall (p < 0.01), for Urgent Care A and B pods (6.4% to 1.2%; p < 0.05), Fast Track C pod (19.3% to 0.0%; p < 0.05) and Behavioral/Substance Abuse D pod (15.7% to 0.0%; p < 0.05) areas of the ED. The critical care room area did not display an improvement (11.4% to 13.2%; p = 0.40).
  
  
  CONCLUSIONS
  Application of HFE methods may aid the development, assessment, and modification of acute care clinical environments through evidence-based design methodologies and contribute to safe patient care delivery.
authors.affiliation: Rhode Island Hospital Medical Simulation Center, Providence, RI, USA. LKobayashi@Lifespan.org
authors.forename: Leo
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Robert M
authors.initials: RM
authors.lastname: Boss
authors.forename: Frantz J
authors.initials: FJ
authors.lastname: Gibbs
authors.forename: Eric
authors.initials: E
authors.lastname: Goldlust
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Hennedy
authors.forename: James E
authors.initials: JE
authors.lastname: Monti
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Siegel
mesh_terms: D003116:Color; D004282:Documentation / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006804:Ergonomics; D005568:Forms and Records Control / Q000592:standards*; D006801:Humans; D017751:Safety Management / Q000379:methods*