Research, design and validation of a cognitive aid to support the reprocessing of flexible endoscopes

The objective of this project was to evaluate human factors based cognitive aids on endoscope reprocessing. The project stems from recent failures in reprocessing (cleaning) endoscopes, contributing to the spread of harmful bacterial and viral agents between patients. Three themes were found to represent a majority of problems: 1) lack of visibility (parts and tools were difficult to identify), 2) high memory demands, and 3) insufficient user feedback. In an effort to improve completion rate and eliminate error, cognitive aids were designed utilizing human factors principles that would replace existing manufacturer visual aids. Then, a usability test was conducted, which compared the endoscope reprocessing performance of novices using the standard manufacturer-provided visual aids and the new cognitive aids. Participants successfully completed 87.1% of the reprocessing procedure in the experimental condition with the use of the cognitive aids, compared to 46.3% in the control condition using only existing support materials. Twenty-five of sixty subtasks showed significant improvement in completion rates. When given a cognitive aid designed with human factors principles, participants were able to more successfully complete the reprocessing task. This resulted in an endoscope that was more likely to be safe for patient use.