Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study
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Ayse P Gurses1, George Kim, Elizabeth A Martinez
1Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. agurses1@jhmi.edu
Insights
Hazards are common in cardiac surgery operating rooms, highlighting many patient safety improvement opportunities. Addressing care provider practices, workload, technology, environment, and processes is crucial for enhancing cardiovascular operating room safety.
Area of Science:
- Cardiovascular Surgery
- Patient Safety
- Human Factors Engineering
Background:
- Cardiac surgery is a high-risk procedure with significant patient safety vulnerabilities.
- The current evidence on safety hazards in the cardiovascular operating room is limited.
- Identifying these hazards is essential for guiding future safety improvements.
Purpose of the Study:
- To identify and categorize hazards in the cardiovascular operating room.
- Hazards are defined as anything with the potential to cause a preventable adverse patient safety event.
Main Methods:
- Prospective methods including direct observations, contextual inquiry, and photographs were used.
- Data were collected during the perioperative period of cardiac surgery across five hospitals (February-September 2008).
- An interdisciplinary team utilized a human factors and systems engineering framework.
Main Results:
- Fifty-eight categories of hazards were identified across 20 observed cardiac surgeries and handoff processes.
- Hazards were categorized by care providers, tasks, tools/technologies, physical environment, organization, and processes.
- Examples include practice variations, high workload, poor usability of technology, cluttered workspaces, hierarchical culture, and non-compliance with guidelines.
Conclusions:
- Hazards are widespread in cardiac surgery, presenting numerous opportunities for safety enhancement.
- Future efforts should prioritize a robust safety culture, improved compliance with infection control, enhanced communication and teamwork.
- Collaboration among stakeholders is needed to optimize the design of tools and technologies for better patient safety.
Background:
Cardiac surgery is a complex, high-risk procedure with potential vulnerabilities for patient safety. The evidence base describing safety hazards in the cardiovascular operating room is underdeveloped but is essential to guide future safety improvement efforts.
Objective:
To identify and categorise hazards (anything that has the potential to cause a preventable adverse patient safety event) in the cardiovascular operating room.
Methods:
An interdisciplinary team of researchers used prospective methods, including direct observations, contextual inquiry and photographs to collect hazard data pertaining to the cardiac surgery perioperative period, which started immediately before the patient was transferred to the operating room and ended immediately after patient handoff to the post-anaesthesia/intensive care unit. Data were collected between February and September 2008 in five hospitals. An interdisciplinary approach that included a human factors and systems engineering framework was used to guide the study.
Results:
Twenty cardiac surgeries including the corresponding handoff processes from operating room to post-anaesthesia/intensive care unit were observed. A total of 58 categories of hazards related to care providers (eg, practice variations), tasks (eg, high workload), tools and technologies (eg, poor usability), physical environment (eg, cluttered workspace), organisation (eg, hierarchical culture) and processes (eg, non-compliance with guidelines) were identified.
Discussion:
Hazards in cardiac surgery services are ubiquitous, indicating numerous opportunities to improve safety. Future efforts should focus on creating a stronger culture of safety in the cardiovascular operating room, increasing compliance with evidence-based infection control practices, improving communication and teamwork, and developing a partnership among all stakeholders to improve the design of tools and technologies.
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