INTERFACES (Jul. 12/23)

Agenda

Quantitative Analyses & Publications, led by Chris Dharma and Marta Maslej

• Chris and Marta will be focussing their publication on whether DASA assessments are associated with real incidents and differences based on characteristics such as demographics and diagnosis, with a focus on first visits only to reduce bias as it typically decreases as clinicians get to know the patients better.
• This will be completed through (1) multilevel regression; (2) Bayesian multilevel models; and (3) generalized estimating equations (GEE)
• The results from all three approaches should converge and agree with one another, but they will primarily focus on the GEE approach.

Completed Analyses
Association Between Race and False Positives

• A relationship between race and false positives was observed when comparing against white race.
• However, when considering multiple admission, it was no longer seen as significant, suggesting that the mode of admission may be a more important factor in predicting false positives.

Intersectional Analysis

• Race and gender were examined, stratified by males and females.
• There were no significant differences found in males, which aligns with existing literature. Among females, race remained a significant factor, particularly for Indigenous, Black, and Middle Eastern individuals.
• It was proposed that racialized women may be facing further criminalization due to certain perceptions and biases. These women may feel compelled to protect themselves more than the average person, potentially leading to misinterpretations of their behaviour as aggressive.
• Questions were raised regarding the history and development of the DASA instrument and its suitability for various settings. The DASA may function differently for men and women and requires further investigation.

Other Adjustments

• Adjustments were made to account for various factors, including age, housing, and admission were conducted. After these adjustments, race was no longer found to be significant.
• These findings suggest that aggression is influenced more by situational and environmental factors.
• The possibility of including postal codes in data requests was discussed as it could offer valuable insights into encounter rates. Marta will look further into her previous data request to obtain location information through postal codes.
• To enhance the visualization and communication of results, the idea of mapping demographic data onto a GTA map was suggested. This could help to convey information more effectively.

The CAMH ED as an Interface of Neurotypes, led by Valeria Khudiakova

• Limited research exists surrounding the challenges faced by autistic service users in understanding their experiences.
• Existing research on autistic service users predominantly focuses on children and adolescents, presenting a knowledge gap concerning adult autistic patients.
• Service users may experiences distress in an ED environment due to sensory sensitivities, such as discomfort with bright lights, textures, or sounds.

Communication Challenges

• Autism presents in diverse ways, and individuals may vary in their abilities and challenges.
• Autistic individuals may face challenges in communication, cognitive inflexibility, and sensory processing, affecting the quality of care they receive.
• The absence of autism-specific accommodations in the ED can have a significant impact on the overall quality of care provided to autistic service users.
• Service users may experience distress in an ED environment due to sensory sensitivities, such as discomfort with bright lights, textures, or sounds.
• Misdiagnosis with conditions such as psychosis due to overlapping symptoms with autism as well as mistreatment can occur. Careful assessment and understanding of autism’s unique characteristics are essential for appropriate care.

The Double Empathy Theory by Damian Milton

• This theory suggests that when individuals with different life experiences interact with one another, they may struggle to empathize with each other, presenting a gap in empathy between individuals such as those who are autistic and non-autistic.
• Past theories have often focused on autistic individuals as being solely responsible for social shortcomings, but the Double Empathy Theory emphasizes that the challenge of understanding each other’s perspectives exists on both sides.
• Healthcare providers may lack specific training in effectively interacting with autistic individuals, highlighting the need for improved understanding and training in this area to ensure better care and support.

Future Work

• Valeria aims to develop a variable to examine the impact of other patients’ diagnoses on interactions with autistic individuals in the ED.
• Certain mental health conditions may have a more significant impact on communication dynamics during interactions with autistic patients. Integrating information about conditions of other patients in the ED could offer valuable insights into how communication is influenced.
• Developing an acuity index was proposed to help evaluate the severity of cases in the ED and provide more tailored interventions.
• Collaborating with TIDES to help develop continuous learning materials for staff was also proposed.

Interfaces, led by Laura Sikstrom and Peter Muirhead

 The Role of Interfaces and Institutional Ethnography

• An interface in the ED refers to the devices and systems that facilitate interactions between different entities.
• A system can refer to emergency care, care stations, and even broader entities like the city of Toronto. Within these systems, different devices are used, such as electronic health records (EHRs), computers, tablets, whiteboards, and written notes, which play a critical role in coordinating work tasks.
• Dashboards are a recent interface development in healthcare technology, gaining popularity in 2019. They offer a new way to interact with data on computers, enhancing data retrieval and accessibility for users.
• Despite advancements, there are often challenges in achieving seamless coordination between devices and systems, which can impact efficiency and care.
• Through institutional ethnography, researchers can gain deeper insights into the complexities of care coordination. Institutional ethnography focuses on understanding how work is organized and coordinated within institutions through texts like standard operating procedures and records.
  
  

A Hazardous Concept by Leo Marx

• This idea suggests that technology is often seen as a self-driven force that shapes and drives societal change.
• Leo Marx argued that this is hazardous because it hides the true relationship between technology and society.
• Instead of technology leading to social change, it is society’s needs, values, and desires that drive the creation and adoption of certain technologies.
• By recognizing the mutual influence between technology and society, we can better grasp technological change and its impact on individuals and communities

“Robots Won’t Save Japan: An Ethnography of Eldercare Automation” by James Wright (2023)

• James Wright challenges the perception that robots are a transformative societal event, 

Sociotechnical Systems

• Sociotechnical systems encompass not only material technology but also policies, procedures, and knowledge that influence how individuals interact with material technologies.
• The definition of sociotechnical systems has evolved over time but it continues to emphasize the view of combining technological and human elements within a system.
• Richard Trahair’s work on behaviour, technology, and organizational development highlights the impact of technology on human behaviour. It emphasizes that technology is not limited to physical devices, including broader social and organizational systems that can affect overall organizational performance.  
• In everyday clinical scenarios, data plays a critical role in patient care and safety. Understanding and effectively using this data are essential for providing high-quality care.

Data Retrieval and Documentation

• In the ED, nurses transfer relevant patient information from EHRs to external sources like Word documents and legal pads to create personalized care plans. Documentation will typically increase with acuity.
• The current computerized templates do not fully align with nurses’ preferred documentation style, impacting the interface’s functionality and coordination of care.
• The use of paper-based or other alternative methods for assessment highlights the importance of considering different technological approaches depending on the specific clinical context.
• Nurses often face challenges in time constraints and legal requirements, having to decide what information to include in their formal records and documentation while maintaining quality of care.
• Staff are impacted further by this due to lack of computer access for PAs and shift changes.
• Staff in the ED created a physical map to track patient locations, treatments, and schedules, serving as an unofficial but key resource. It provides information verification that current digital tools are not offering.

Next meeting: August 28^th, 10AM – 1PM

Theme: Teaming

• Marta will provide an overview of the upcoming year and Laura will present on simulations
• Team to plan a summer showcase for Trainees in September and an alumni meeting in October
• Call for abstracts for the T-CAIREM AI in Medicine Conference close on July 31^st

       https://tcairem-conference.ca/abstracts/