Research Chair: Patricia Trbovich, PhD
Patricia Trbovich holds the Badeau Family Research Chair in Patient Safety and Quality Improvement at North York General Hospital and is Associate Professor of Quality Improvement and Patient Safety in the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto. She is the Research and Scholarship Lead at the Centre for Quality Improvement and Patient Safety (CQuIPS), leads the HumanEra team and holds cross appointments at the Institute of Biomedical Engineering (IBME) at the University of Toronto and within TECHNA at the University Health Network.
Patricia's areas of expertise include human factors engineering and patient safety. She has made significant contributions to research through evaluations of medical technology such as smart infusion pumps, and has offered evidence-based recommendations regarding their implementation in the health system. She has also conducted extensive research on mitigation of interruptions on delivery of high-risk medical procedures. Her team was recognized with the 2015 Patient Safety Award from the Association for the Advancement of Medical Instrumentation and Becton Dickinson.
Dr. Trbovich has received funding for her field evaluation and Human Factors Engineering research through various national granting agencies including the Canadian Institutes of Health Research (CIHR), the National Sciences and Engineering Research Council (NSERC) and the Canadian Patient Safety Institute (CPSI). She has collaborated with Brazilian colleagues on a research grant to introduce human factors engineering in Brazil. She has also collaborated with the University Marques de Valdecilla, a public hospital, located in Santander, Cantabria, Spain on a joint research and training program. She is Associate Editor for the BMJ Quality and Safety journal.
The HumanEra team
Dr. Trbovich leads HumanEra, an applied human factors research team based at the Institute of Health Policy, Management and Evaluation (University of Toronto) and at Research and Innovation (North York General Hospital). HumanEra's approach focuses on holistically capturing the interactions between people, technology, the environments in which they work, and the processes they facilitate.
The team engages with the full spectrum of stakeholders (from frontline staff to patients, support workers, and organizational/policy decision-makers) by using methods such as clinical observations and in-situ and laboratory-based simulations. As a result, HumanEra: captures the complexity of day-to-day operations; designs interventions that are informed by and supported by those most affected; quantifies improvements in rigorous simulation; and maximizes the probability of intervention uptake, an ongoing challenge facing the health system today.
Key areas of work
Operating Room Data Recorder
North York General Hospital will be the second hospital in Ontario to use the Operating Room Data Recorder (Black Box), thanks to the Steinberg Family Surgical Safety Program. Our team will seek to answer a variety of questions related to the non-technical performance of the surgical team, the usability and efficiency of human to environment or human to technology interactions, and how the team's recognition of uncertainty can be measured. The results of this work may provide insights to the surgical team in North York General Hospital, but also teams worldwide with regards to optimal surgical practice, and improve both patient and staff safety.
Opioid stewardship in primary care, hospitals and home environments
Our team has embarked on multiple projects to reduce harms related to opioid use.
In primary care settings, we have designed and evaluated a decision support tool that facilitates conversations between family physicians and their patients. The tool collects patient information and comments while they are in the waiting room and instantly uploads this information to the physician's electronic medical record. As a result, both the patient and physician can walk through a structured discussion with regards to the patient's pain symptoms and medication plan.
In hospitals, we are embarking on a multiphase study to understand how opioids and other controlled drugs are accounted for and tracked, while continuously seeking to reduce the burden on clinicians to recount, witness and co-sign transactions. This important work contributes to an understudied area, and will inform Canadian hospitals of potential risks and mitigating strategies.
We are also cognizant that opioids have been stolen from home settings, or have accidentally been ingested by children and pets. To this end, we have also developed a concise information card for patients that provide reminders and advice with regards to 1) safely storing opioids in the home, and 2) where to dispose of unfinished opioids when no longer needed. We are exploring additional collaborations to continue this work.
The Critical Care Unit (CCU) of the Hospital for Sick Children (SickKids) is collaborating with HumanEra to embed human factors expertise as part of their ongoing commitment to improve patient safety. This collaborative project will identify opportunities for patient safety improvement within the critical care environment, as well as design and test interventions to improve clinical practices.
Currently, HumanEra is using mixed-methods to gain a comprehensive understanding of information exchangein the CCU. In particular, data collection will focus on interdisciplinary rounds (and peripheral activities such as preparing for rounds) in qualitative and quantitative detail. Interdisciplinary rounds provide a forum for clinicians to review patients' status, discuss treatment and make crucial care decisions. Communication failures at this stage can have a profoundly negative impact on critically-ill patients. Research that seeks to understand and optimize the conditions that support clinical communication events may have important implications for patient safety.
Phone: North York General Hospital: 416-756-6000 x3075
University of Toronto, Institute of Health Policy Management and Evaluation: 416-978-4210
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Institute of Biomedical Engineering, University of Toronto
- TECHNA, an institute of University Health Network
- Research and Scholarship Lead, Centre for Quality Improvement and Patient Safety