Providing Another LENS on Cardiovascular Surgery Using

Transcription

Providing Another LENS on Cardiovascular
Surgery Using RIPCHORD
A self-assessment tool allowing cardiac teams to identify the
nature and frequency of flow disruptions in the operating room
Olivia D. Crowe, BS
Doctoral Student, Embry-Riddle Aeronautical University
Jennifer Cabrera, BS
Tara Cohen, BA
Erin Pohl, BA
Kristen Welsh, BA, BS
Albert J. Boquet, PhD
Professor, Embry-Riddle Aeronautical University
Scott Shappell, PhD
Professor and Chair, Dept. of Human Factors and Systems,
Embry-Riddle Aeronautical University
Background
 Architectural study
 sought to develop an initial methodology for
identifying and classifying flow disruptions
in the cardiac OR
 10 cardiac operations observed
 1,080 observations
 Development of a robust taxonomy
 six categories: communication, usability,
physical layout, environmental hazards,
general interruptions, and equipment
failures
RIPCHORD
Realizing Improved Patient Care
through Human-centered Operating Room Design
RIPCHORD 1.0
Observational Taxonomy
 Communication (verbal and non-verbal)


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
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
Poor Communication
Lack of Response
Confusion
Simultaneous Communication
Non-essential Communication
Environmental Noise
 Usability






Computer
Equipment
Surfaces
Barriers
Packaging
Data Entry (non-computer)
 Layout






Connector Positioning
Equipment Positioning
Furniture Positioning
Permanent Structures Positioning
Inadequate Use of Space
Impeded Visibility
 Interruptions









Phone Calls
Pages
Non-essential Personnel
Spilling/Dropping Items
Teaching Moments
Outside Distractions
Shift Changes
Searching Activity
Common Information
 Environmental Hazards
 Slipping/Falling
 Sharps
 Crushing
 Equipment Failure
 Surgeons Equipment
 Anesthesia Equipment
 Perfusion Equipment
RIPCHORD 2.0








Poor Communication
Lack of Response
Confusion
Environmental Noise
Ambiguous Communication
Lack of Sharing
 Usability






Computer
Equipment
Surfaces
Barriers
Packaging
Data Entry (non-computer)
 Layout






Inadequate Use of Space
Impeded Visibility
 Interruptions









Phone Calls/Pages/Texts
Non-essential Personnel
Teaching Moments
Shift Changes
Searching Activity
Equipment/Supplies
Wires/Tubing
 Coordination and Planning





Personnel Rotation/Scheduling
Personnel Not Available
Common Information
Procedural Failure
Planning and Preparation
 Environmental Hazards





Slipping/Falling
Sharps
Crushing
Fluids
Contaminated Equipment
 Equipment Failure


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
Surgeons Equipment
Anesthesia Equipment
Perfusion Equipment
General Equipment
Flow Disruption
 Events that disrupt the flow or natural progression
of the procedure
 Distract attention away from the primary task
 Increase the likelihood of errors which can cause
sentinel events to occur in the OR
Palmer, G., et. al., (2013)
Methods: Data Management
LENS Database (14,070)
- Good Practices
- Hazards
- Preferences or Variations
- Time
Hazards (5,290)
Eliminated Duplicates (3,956)
Categorized/Coded (1,334)
- RIPCHORD 24.59% (298)
Results: RIPCHORD
Frequency of Flow Disruptions by Major Categories
0.28
0.24
0.20
0.09
0.09
0.08
0.02
Communication
Coordination
Usability
Layout
Environmental
Hazards
Interruptions
(0ther)
Equipment
Issues
Results: RIPCHORD
Frequency of Flow Disruptions by Coordination Subcategory
0.50
0.18
0.17
0.09
0.04
Planning/Preparation
Scheduling
0.02
Procedural Failure
Personnel Rotation
Common Information
Personnel Not
Available
Results: RIPCHORD
“After the patient was prepped and draped the PA said that
the patient needed to be pulled down. Much more difficult
and potential risk for contamination.”
0.50
0.18
0.17
0.09
0.04
Scheduling
0.02
Procedural Failure
Personnel Rotation
Common Information
Personnel Not
Available
Results: RIPCHORD
0.50
Common Information
Surgical fellow to scrub nurse, ‘do you have the real rib
spreaders?’ after he was handed the incorrect equipment. ‘No,
not the chest spreaders.’
0.18
0.17
0.09
0.04
Scheduling
0.02
Procedural Failure
Personnel Rotation
Common Information
Personnel Not
Available
Results: RIPCHORD
0.50
“Resident (anesthesia) was struggling with the line placement.
Attending was not in room. Needed more supervision.”
0.18
0.17
0.09
0.04
Scheduling
0.02
Procedural Failure
Personnel Rotation
Common Information
Personnel Not
Available
Results: RIPCHORD
Procedural Failure
“Resident and fellow are shaving the leg. AA told them
to stop (because patient was not draped and risk for
cross-contamination and SSI).”
0.50
0.18
0.17
0.09
0.04
Scheduling
0.02
Procedural Failure
Personnel Rotation
Common Information
Personnel Not
Available
Results: RIPCHORD
Frequency of Flow Disruptions by Communication Subcategory
0.33
0.18
0.15
0.13
0.07
0.07
0.06
0.01
Ineffective
Communication
Lack of
Response
Lack of
Sharing
Ambiguous
Communication
Confusion
Simultaneous
Non-essential
Communication Communication
Environmental
Noise
Results: RIPCHORD
Lack of Sharing
“Anesthesia. “What are we giving
there?” CRNA to attending
anesthesiologist' inquiry as to what
medication the attending was giving.
The attending had not shared with her
up front what it was.”
0.33
0.18
0.15
0.13
0.07
0.07
0.06
0.01
Ineffective
Communication
Lack of
Response
Lack of
Sharing
Ambiguous
Communication
Confusion
Simultaneous
Non-essential
Environmental
Noise
Results: RIPCHORD
Lack of Response
“Surgeon asked to see the TEE. Neither
anesthesia resident heard him. He called
AR1 by name and asked him to move the
monitor so that he could see it.”
0.33
0.18
0.15
0.13
0.07
0.07
0.06
0.01
Ineffective
Communication
Lack of
Response
Lack of
Sharing
Ambiguous
Communication
Confusion
Simultaneous
Non-essential
Environmental
Noise
Results: RIPCHORD
Confusion
“AR1 “CVP high, stuck.” AR2 “What’s high
buddy?” AR1 “CVP here what was our
number again?” Perfusion student “you
mean ACT?” AR1 “yes” Perfusion student
“112.”
0.33
0.18
0.15
0.13
0.07
0.07
0.06
0.01
Ineffective
Communication
Lack of
Response
Lack of
Sharing
Ambiguous
Communication
Confusion
Simultaneous
Non-essential
Environmental
Noise
Results: RIPCHORD
0.33
0.18
Ambiguous Communication
“Surgeon “Where you at, 25? 250?”
Perfusion “At 2” Surgeon “Were you at 250
before?” Perfusion “No at 2” Surgeon,
somewhat exasperated “200?” Perfusion
“Yes” Surgeon “How much is in?” Perfusion
“300 in” Surgeon “Off on plege” Perfusion
“Off on plege.”
0.15
0.13
0.07
0.07
0.06
0.01
Ineffective
Communication
Lack of
Response
Lack of
Sharing
Ambiguous
Communication
Confusion
Simultaneous
Non-essential
Environmental
Noise
Results: RIPCHORD
Frequency of Flow Disruptions by Interruption Subcategory
0.33
0.30
0.16
0.08
0.07
0.07
0.00
0.00
Phone
Calls/Pages/Texts
Non-essential
Personnel
Spilling/Dropping
Items
Teaching Moments
Outside
Distractions
Searching Activity
Medical Alert
Equipment/Supplies
Results: RIPCHORD
0.30
Equipment/Supplies
“Surgeon to perfusion “Do you have a
smaller veinous cannula?” Circulator
“Uh, smaller veinous cannula? Yes, I
have to run out & get that.” Left &
came back “This is a 2836.” Surgeon
“all right, we’ll use that.”
0.33
0.16
0.08
0.07
0.07
0.00
0.00
Phone
Calls/Pages/Texts
Non-essential
Personnel
Spilling/Dropping
Items
Teaching Moments
Outside
Distractions
Searching Activity
Medical Alert
Equipment/Supplies
Results: RIPCHORD
0.30
0.16
“The anesthesia team removed
the “batwing” from the head of
the patient’s bed. As they
removed it the TEE probe fell (it
had been perched on the smart
pump). The probe did not fall
out of the patient’s mouth but
made quite a jerk as it landed
on the floor. ”
0.33
0.08
0.07
0.07
0.00
0.00
Phone
Calls/Pages/Texts
Non-essential
Personnel
Spilling/Dropping
Items
Teaching Moments
Outside
Distractions
Searching Activity
Medical Alert
Equipment/Supplies
Results: RIPCHORD
0.30
0.16
Teaching Moments
“Delay in connecting perfusion
tubing by scrub nurse who
wasn't certain how to do it. Had
adequate(appropriate)supervisi
on and direction from senior
nurse who was in the room appears that she was in
training.”
0.33
0.08
0.07
0.07
0.00
0.00
Phone
Calls/Pages/Texts
Non-essential
Personnel
Spilling/Dropping
Items
Teaching Moments
Outside
Distractions
Searching Activity
Medical Alert
Equipment/Supplies
Conclusions
Flow disruptions observed in the CVOR
 Largely populated in Coordination (28%),
Communication (24%) and Interruptions (20%)
categories
 largest percentage accounted for in Coordination by
“Planning/Preparation” (60%)
 largest percentage accounted for in Communication by
“Lack of Sharing” (33%)
 largest percentage accounted for in Interruptions by
“Equipment/Supplies” (33%)
Conclusions
Results compared to the original architectural study
 Heavily represented by Layout (31%), Interruptions
(24%) and Usability (20%) categories
 Specifically looking at architecture and design
 Communication accounted for 15%
Conclusions
 RIPCHORD Validation
 modification required
 RIPCHORD 3.0
Current Research:
Interdisciplinary Study
to identify flow
disruptions
threatening specific
clinical specialties
of the
cardiothoracic
surgical team
RIPCHORD: Newest Edition







Computer Design
Equipment Design
Surfaces Design
Barriers Design
Packaging Design
Data Entry (non-computer) Design
 Layout















Ineffective Communication
Lack of Response
Confusion
Environmental Noise
Lack of Sharing
 Usability






 Interruptions (Other)
Inadequate Space
Wires/Tubing
Distractions
Teaching Moments
Searching Activity
Alerts
Equipment/Supplies
Slipping/Falling
Interaction with Biohazards







Personnel Rotation
Common Information
Protocol Failure
Scheduling
Charting/Documentation
 Equipment Issues




Surgeons Equipment
Perfusion Equipment
General Equipment
RIPCHORD: Newest Edition







Computer Design
Equipment Design
Surfaces Design
Barriers Design
Packaging Design
Data Entry (non-computer) Design
 Layout















Ineffective Communication
Lack of Response
Confusion
Environmental Noise
Lack of Sharing
 Usability






 Interruptions (Other)
Inadequate Space
Wires/Tubing
Distractions
Teaching Moments
Searching Activity
Alerts
Equipment/Supplies
Slipping/Falling
Interaction with Biohazards







Personnel Rotation
Common Information
Protocol Failure
Scheduling
Charting/Documentation
 Equipment Issues




Surgeons Equipment
Perfusion Equipment
General Equipment
Thank You
Questions?
Contacts:
 Olivia Crowe, [email protected]
 Scott Shappell, [email protected]
 Bert Boquet, [email protected]

Providing Another LENS on Cardiovascular Surgery Using

Transcription

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