Lighting and Ed Clinician Wellness and Performance Improvement
BACKGROUND. Short wavelength (‘blue’) light is known to mediate ‘non-visual’ effects of light in humans. These effects, that go beyond the pure ‘visual’ function, can affect human wellness and performance, as it has been reported in previous scientific research in laboratory, office, education, clinical and aero-space setups. In healthcare research, lighting has been recognized in the fields of human factors, ergonomics, and systems engineering, as an environmental factor that can affect the quality of the delivery of care; in particular, clinician wellness and performance, and the occurrence of medical error.
RESEARCH QUESTION AND HYPOTHESIS. The aim and novelty of this research is to study the potentially beneficial ‘non-visual’ effects of lighting in the clinical environment, to advance ‘patient-safety’. The hypothesis of this study was that clinician wellness and performance in the execution of clinical procedures at the emergency department (ED) could be improved through controlled, indirect, ‘blue’-regulated, full visible spectrum, tunable, solid state, ‘white’ lighting, compared to prevalent fluorescent lighting conditions.
METHODS. To conduct our inquiry, we performed a randomized AB/BA crossover experimental study with ten actual ED clinicians that executed ED clinical procedures, under two lighting conditions, in a realistic ED clinical setting. The experiments took place at the ED simulation center at Mount Sinai Hospital in New York City (ED-STAR) with a high fidelity human patient simulator (HPS). The ED clinicians carried out a ‘glidescope assisted laryngoscopy and endotracheal intubation’ (airway) and a ‘surgical tube thoracostomy’ (chest-tube). For the lighting conditions, we used the existing fluorescent lighting as control. To provide the appropriate experimental lighting condition, we developed a novel multichannel solid state lighting system for precise control and assessment of the light spectrum, with specific emphasis in the short wavelength spectral area. We provided the same horizontal illuminance at the task (mannequin chest) under both lighting conditions (880 lux). The correlated color temperature under fluorescent lighting was 4,000K, and 78,000K under experimental. The spectral power distribution (SPD) of the lighting conditions was assessed with calibrated spectrophotometers. Indoor environmental quality (IEQ) was assessed through surveys and measurements (noise, air temperature, air relative humidity, and carbon dioxide levels).
FINDINGS/RESULTS. The main observed outcomes of this study are: a significant reduction in clinician sleepiness perception (Karolinska Sleepiness Scale, -15.94%, p=0.022) and workload perception (NASA-TLX, -21.87%, p=0.009), a reduction in clinical procedures execution time (-21.04%), and a reduction in the occurrence of medical error. The experimental condition (78,000K) was also preferred by the clinicians compared to the fluorescent lighting (4,000K), favoring the translatability from the simulation to the clinical environment.
FUTURE WORK. Future work is to expand the scope of this study to advance ‘patient-safety’ in related clinical situations where prevalence of adverse events has been observed, such as: clinician cognitive recovery from medical error, hand-offs events, and improvement of teamwork conditions. Dynamic lighting, temporal effects, ethics, human variability factors, and the interoperability between lighting systems and human psycho-physiological variables will be considered.
DISCLOSURE OF FUNDS. This research was funded by NIH/NCATS.