Human reliability analysis of bronchoscope-assisted percutaneous dilatational tracheostomy: implications for...

Area of Science:

• Medical Education
• Patient Safety
• Procedure Analysis

Background:

• Clinical procedure training and assessment necessitate detailed step identification.
• Human reliability analysis (HRA), common in high-risk industries, is underutilized in healthcare.
• HRA offers potential for simulation-based education (SBE) in both training and performance evaluation.

Purpose of the Study:

• To apply HRA to identify procedural steps and associated risks for bronchoscope-assisted percutaneous dilatational tracheostomy (BPDT).
• To establish a framework for using HRA in clinical procedure training and assessment.

Main Methods:

• Hierarchical task analysis (HTA) was employed to define BPDT subgoals (steps).
• The Systematic Human Error Reduction and Prediction Approach (SHERPA) was used to identify potential errors, risks, and preventive strategies for each subgoal.

Main Results:

• The BPDT procedure was delineated into 395 subgoals.
• 18% of these subgoals were identified as high-risk.
• Key risk reduction strategies included checklists, audits, mandatory training, simulation, consultant involvement, and a safety-focused culture.

Conclusions:

• This study presents a systematic HRA-based method for clinical procedure step identification, crucial for SBE.
• Understanding procedural steps is foundational for effective SBE.
• HRA provides a structured method for teaching technical procedures and delivering performance feedback.