Research Overview
The SED Lab examines the role of sociotechnical systems factors in supporting or hindering safety in clinical systems, with specific interests in surgical instrument reprocessing, robotic-assisted surgery, anesthesia medication delivery, and retained foreign objects. Complementing the social determinants of health framework, our research also leverages human factors and systems engineering to examine clinical systems' contributions to healthcare disparities.
Current Projects
Maternal Health & Disparities
PIs: Prof. Myrtede Alfred & Dr. Dulaney Wilson (MUSC)
Collaborators: Medical University of South Carolina (US), University of Texas, El Paso (US), University of Texas, San Antonio (US)
Lab Members: Anna Szatan, Esosa Igbinakenzua, Deenar Virani, Rob (Hongbo) Chen
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A significant portion of maternal deaths and severe maternal morbidity in the US are preventable with timely and appropriate care. The study proposes to conduct a comprehensive systems investigation of maternal care by combining prospective systems analysis based on human factors methods; retrospective analysis of unsafe condition reports; and data analysis of patient safety incidences disaggregated by race/ethnicity. The findings from this research will inform interventions that improve safety in maternal care and reduce racial/ethnic disparities.
Investigating Safety and Efficiency in the Transport Process: Emergency Department to Diagnostic Imaging
PI: Prof. Myrtede Alfred
Lab Members: Hongchen (Flora) Liu
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"Investigating Safety and Efficiency in the Transport Process: Emergency Department to Diagnostic Imaging," was conducted from May to August 2024 at William Osler Health System (Osler). The study aimed to identify barriers and challenges associated with the use of the patient transfer safety checklist for ED patients transported to and from DI. It also sought to develop recommendations to enhance checklist compliance and reduce adverse incidents during transport. The findings of this study provide a roadmap for hospitals to implement strategies and recommendations grounded in human factors (HF) principles, which is particularly relevant as Osler plans to introduce a new Hospital Information System (HIS), Epic, in 2026.
The Efficacy of Integrating Tactile Feedback to Improve Bystander Cardiopulmonary Resuscitation (B-CPR) Quality
PI: Prof. Myrtede Alfred
Current Lab Members: Huda Musa, Joey Lu, Allan Zhou
Former Lab Members: Nicole Hicks, Francesca Fortino, Tochi Oramasionwu, Andreas Constas, Alex Zhang, Wei Fung
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35 000 Canadians experience out of hospital cardiac arrests (OHCA) each year and only 1 in 10 of these individuals survive. Performing immediate high-quality CPR can help drastically increase chances of survival - however, bystanders often perform CPR incorrectly. While feedback devices have been developed to guide users with their chest compression depth and rate, these devices are often distracting. Instead, integrating haptic feedback with devices allows the bystander to directly receive data, through vibrations to the hand, on the quality of their chest compressions. To test performance of the tactile feedback device, the team is using a multimodal feedback device with an internal accelerometer to track compression depth and provide audio feedback. 16-24 participants will be recruited for a cardiac arrest simulated scenario study, facilitated by a manikin. Half of the participants will have access to feedback in trial 1 only, and the other half in trial 2 only. Performance data will be collected, including compression depth, rate and percentage accuracy, to compare changes in CPR performance between the feedback and non-feedback trials. B-CPR is a life-saving action for someone experiencing an OHCA. Integrating tactile feedback in CPR devices can be an easy and effective solution to help bystanders increase their CPR quality and save a life.
Improving Equity in Maternal Care
PI: Prof. Myrtede Alfred
Current Lab Members: Tosin Akintunde
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This study focuses on improving equity in maternal care by integrating an equity lens into human factors and systems engineering approaches to investigate clinical system factors contributing to adverse outcomes and racial disparities. Currently, a study is being conducted to identify systemic factors driving these disparities. Moving forward, the equity challenges Black women and birthing persons face across prenatal, intrapartum, and postpartum phases will be examined. Additionally, a participatory study will be led that empowers Black women and birthing persons to collaboratively reimagine equitable maternal care. Ultimately, the research aims to inform the redesign of care pathways to enhance maternal outcomes and promote equity in care.
Incorporating Equity Review Methods into the Serious Safety Event (SSE) Review Process
PI: Prof. Myrtede Alfred
Current Lab Members: Deenar Virani
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Deenar Virani is an Master of Applied Science student in Mechanical and Industrial Engineering at the SED Lab. Her research focuses on patient safety, incident reporting systems, and health equity. During her undergraduate degree in Industrial Engineering, she completed a project at the SED Lab focusing on investigating systems factors contributing to adverse events in maternal care using incident reports. She also worked with Scarborough Health Network for her capstone project, to improve the UI and UX of their patient safety incident reporting system. Currently, she is working with Unity Health Toronto to design and incorporate equity review methods into the serious safety event (SSE) review process.
Checklists in healthcare - A Systematic Review and Database Project
PI: Prof. Myrtede Alfred
Collaborators: Laura Barg-Walkow, Joe Keebler, Alex Chaparro
Current Lab Members: Matthew Chambers, Izhaan Junaid, Jasmine Zhan
Former Lab Members: Andrea Bolanos Mendez, Lisa Mtui, Skye Wongapisumpo, Jingjing (Isabel) Zhan
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Checklists can support patient care in a range of clinical settings. While many healthcare institutions develop their own, agencies such as the World Health Organization (WHO) have also designed checklists for hospitals worldwide. Although checklists are effective interventions, overuse, and poor design or implementation limit their utility and sustainability in healthcare environments.
The purpose of our research was to examine the effectiveness of checklists utilized in different clinical settings in order to support proper design and implementation of checklists. Additionally, as checklists developed for clinical use may not be disseminated outside the organization or the research community, we collected checklists found in these studies to develop a checklist database.
Link to database: https://borealisdata.ca/dataverse/Checklist_Project
Using Patient Journey Mapping to Design Equitable Maternal Care
PI: Prof. Myrtede Alfred
Current Lab Members: Nicole Hicks, Layla Atallah, LinQiao Zhang
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With over 3.8 million births annually, giving birth is among the most common causes of hospitalization in the United States (US).Despite having the most expensive maternity care in the world, outcomes for US mothers are poor, worsening and reflect deep racial and ethnic health disparities. The maternal mortality rate in the US was 23.8 deaths in 2020; rising from 20.1 in 2019. Women of color are 2-3 times more likely to die and experience higher rates of severe maternal morbidity (SMM). An estimated 45-60% of all maternal deaths and SMM are preventable with timely, respectful, and risk-appropriate care.
Maternity care is a critical time for health care teams to establish and maintain patient trust and for patients to establish healthy habits and positive routines for utilizing clinical and community resources during. Women have identified these goals as requiring thorough and continuous health care support through the continuum of prenatal and postpartum periods.
Documenting patients’ experiences of prenatal, in-patient, and postpartum care through patient journey mapping about their information needs, emotions, and logistics centers the patient perspective on facilitators and barriers to care. This innovative approach is critical to improving maternal care, reducing disparities, and providing women with agency in the redesign of systems of care. Few studies have examined the contribution of clinical systems that disadvantage particular groups to the persistent disparities in maternal health care and adverse outcomes. Therefore, we propose to 1) examine latent threats in maternal care through direct observation and 2) map patients’ care experiences during pregnancy and postpartum to identify modifiable processes and evaluate practices to improve safety, equity, and patient-centered maternal care.
Dashboard Project: Developing and Testing a Visual Feedback Mechanism to Monitor System Equity
PI: Prof. Myrtede Alfred
Current Lab Members: Tosin Akintunde, Fiona Sun, Max Bao
Current systems analysis approaches used in patient safety and risk mitigation do investigate inequities nor account for unique and disproportionate risks for marginalized populations created by systemic design biases. Process and outcome measures are not typically disaggregated or stratified by race/ethnicity, however, doing so facilitates identification of variations, and provide insight on sociotechnical factors contribute to variations in adverse outcomes. My research lab has completed preliminary analysis on maternal health data to statistically test for racial/ethnic inequities in processes and outcome. However, in order to monitor system equity, data analysis results need to be analyzed in real-time and presented to in a manner that facilitates understanding and decision-making. The proposed project will involve designing and test a feedback mechanism (e.g., dashboard) to visually represent the findings of the statistical and qualitative data analysis. The dashboard will include visual analytics that mimic statistical process control charts and distributions to compare expected and actual outcomes according to the defined comparison (racialised women) and reference group (white women), historical outcomes (adverse events), processes (delivery type), and goals (reducing blood transfusions). This tool will be able to support ongoing monitoring of inequitable process and outcome variances for racialised women. The interface will be tested with stakeholders including patient safety coordinators. While the dashboard will not present real-time data, we can examine historical data to establish a baseline to support quarterly or monthly equity assessments.
Mobile Applications as Preoperative Surgery Preparation for Children
PI: Prof. Myrtede Alfred
Current Lab Members: Michelle Lai
Surgical procedures are a significant cause of anxiety in many children, where up to 60% of children suffer anxiety in the presurgical period of a surgery involving anaesthesia. Elevated preoperative anxiety in pediatric patients can significantly hinder post-operative recovery, resulting in prolonged healing times, diminished pain management, and adverse effects on the child’s ability to cope with future medical encounters. However, evidence suggests that effective preoperative preparation programs can substantially alleviate anxiety in children.This research evaluates the usability of PeaceOfMind, a mobile application designed to provide interactive, child-friendly education for children preparing for surgery. To begin, a narrative review will compare existing and emerging preoperative preparation interventions within pediatrics. Using a mixed-methods approach, the study then combines expert interviews, usability testing with children aged 6–12, and data analysis to refine the application’s design and assess its effectiveness in improving pediatric