Observation and Categorization of Process Inefficiencies Related to Cardiopulmonary Bypass
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1 Observation and Categorization of Process Inefficiencies Related to Cardiopulmonary Bypass Erin E. Pohl, B.A/Speaker Embry-Riddle Aeronautical University Daytona Beach, FL
2 I have no disclosures Disclosures
3 Overview Define Human Factors Psychology Process Inefficiencies in Systems Methods RIPCHORD Taxonomy Results Discussion Take Home Points
4 What is Human Factors Psychology? scientific discipline that studies the relationship between humans and technology characteristics of human beings that are applicable to the design of systems and devices improve human/system interaction by designing safe and effective systems using a blend of engineering and psychological principles
5 Process Inefficiencies in Systems What are flow disruptions? deviations from the natural progression of a process 1,2 introduce unwanted distractions and open the door for errors to occur 3 provide both quantitative measures and qualitative detail about the processes that create inefficiencies and risk in healthcare systems 4
6 Process Inefficiencies in Systems Why study flow disruptions? obtain a baseline measure for interruptions gives us the ability to make comparisons before and after interventions are implemented allows us to better develop evidence-based interventions
7 Methods Medical University of South Carolina prospective observation in real-time 10 cases in CVOR embedded in 3 specialties: perfusion, circulating nurse, anesthesia classified flow disruptions using RIPCHORD taxonomy
8 RIPCHORD* Taxonomy *Realizing Improved Patient Care through Human-centered Operating Room Design Communication Ineffective Communication Lack of Response Confusion Simultaneous Communication Nonessential Communication Environmental Noise Lack of Sharing Coordination Personnel Rotation Personnel Not Available Unknown Information Protocol Failure Charting/Documentation Planning/Preparation Layout Connector Positioning Equipment Positioning Furniture Positioning Permanent Structures Positioning Inadequate Space Wires/Tubing Usability Computer Design Equipment Design Surface Design Barrier Design Packaging Design Data Entry Design Interruptions Equipment Issues Distractions Surgeon Equipment Teaching Moments Anesthesia Equipment Searching Activity Perfusion Equipment Task Deviation General Equipment Alerts Equipment/Supplies Spilling/Dropping Interaction with Biohazards
9 Results a total of 872 flow disruptions were identified during 10 observed cases per discipline in the CVOR perfusion (261) circulating nurse (298) anesthesia (313) this translates to a total of 254 minutes (>4hrs) that perfusionists spent recovering from flow disruptions
10 Results Frequency of Flow Disruptions by Major Category Communication Coordination Equipment Issues Interruptions Layout Usability
11 Results Total Time of Flow Disruptions by Major Category (min) Communication Coordination Equipment Issues Interruptions Layout Usability
12 Results Efficiency Ratio of Flow Disruptions by Major Category Communication Coordination Equipment Issues Interruptions Layout Usability
13 Results Interruptions Flow Disruptions (%) Alerts Distrac2ons Equipment/Supplies Interac2ons with Biohazards Searching Ac2vity Spilling/Dropping Task Devia2on Teaching Moments
14 Results Layout Flow Disruptions (%) Connector Posi2oning Equipment Posi2oning Furniture Posi2oning Inadequate Space Permanent Structures Posi2oning Wires/Tubing
15 Results Communication Flow Disruptions (%) Confusion Environmental Noise Ineffective Communication Lack of Response Lack of Sharing Nonessential Communication Simultaneous Communication
16 Discussion issues surrounding general interruptions, layout and communication may distract or otherwise impair the ability of perfusionists to perform at their best flow disruptions which occur at critical times during the surgery may pose a greater risk no one-size-fits-all solution
17 Take Home Points Benefits of Human Factors in CVOR Flow Disruptions Interruptions/Layout/Communication Frequency vs. Time: One-Size Doesn t Fit All System vulnerabilities/inefficiencies Next Steps/Recommendations SME involvement in design and development of targeted interventions
18 References 1 Wiegmann, D.A., ElBardissi, A.W., Dearani, J.A., Daly, R.C., & Sundt, T.M. (2007). Disruptions in surgical flow and their relationship to surgical errors: An exploratory investigation. Surgery, 142, Shouhed, D., Blocker, R., Gangi, A., Ley, E., Blaha, J., Margulies, D., Wiegmann, D., Starnes, B., Karl, C., Karl, R., Gewertz, B., & Catchpole, K. (2014). Flow disruptions during trauma care. World Journal of Surgery, 38, Palmer, G., Abernathy, J.H., Swinton, G., Allison, D., Greenstein, J., Shappell, S., Juang, K., & Reeves, S.T. (2013). Realizing improved patient care through humancentered operating room design: A human factors methodology for observing flow disruptions in the cardiothoracic operating room. Anesthesiology, 119(5), Catchpole, K., Gangi, A., Blocker, R., Ley, E., Blaha, J., Gewertz, B., & Wiegmann, D. (2013). Flow disruptions in trauma care handoffs. Journal of Surgical Research, 184,
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