Identifying and reducing risks in functional endoscopic sinus surgery through a hierarchical task analysis.

Area of Science:

• Surgical Procedures
• Patient Safety
• Medical Education

Background:

• Functional Endoscopic Sinus Surgery (FESS) requires precise execution.
• Identifying potential errors in FESS is crucial for improving surgical outcomes.

Purpose of the Study:

• To develop a hierarchical task list for successful FESS.
• To conduct a technical and human factor analysis of FESS tasks to identify and mitigate errors.

Main Methods:

• A triangulation of methods including literature review, surgical observations, and surgeon interviews.
• Hierarchical Task Analysis (HTA) was used to map FESS procedures.
• Systematic Human Error Reduction and Prediction Approach (SHERPA) was applied to identify risks and mitigation strategies.

Main Results:

• Identified 10 tasks and 49 subtasks for FESS based on expert consensus.
• Calculated risk scores for each subtask and detailed risk reduction methods.
• Demonstrated the utility of HTA and SHERPA in standardizing clinical practice and enhancing patient safety.

Conclusions:

• Hierarchical Task Analysis (HTA) and SHERPA are effective tools for deconstructing expert performance in FESS.
• These methods highlight potential errors and serve as valuable learning and assessment tools for novice surgeons.
• The findings offer opportunities to improve surgical training and patient safety by addressing high-risk FESS steps.