The application of human reliability analysis to carpal tunnel decompression

Area of Science:

• Surgical training and patient safety
• Human factors in medicine
• Medical error reduction

Background:

• Surgical procedures carry inherent risks of human error, especially during skill acquisition.
• Task standardization alone does not address human factors in surgical learning.
• Human reliability analysis (HRA) offers a structured method to evaluate and mitigate human error in surgical contexts.

Purpose of the Study:

• To apply HRA methodologies to analyze skills acquisition in carpal tunnel decompression.
• To identify potential human errors, their associated risks, and preventive strategies in this surgical procedure.

Main Methods:

• Hierarchical task analysis (HTA) was used to break down carpal tunnel decompression into 46 subtasks.
• The Systematic Human Error Reduction and Prediction Approach (SHERPA) was employed with subject matter experts.
• Potential errors, risk levels, and preventative measures were identified for each subtask.

Main Results:

• Carpal tunnel decompression involved 46 subtasks, with 45% medium risk and 55% low risk.
• High probability errors (e.g., incorrect tourniquet size, improper local anesthetic infiltration) were identified in 9% of subtasks.
• Critical errors included failure to aspirate before anesthetic injection (6% of subtasks). Remedial strategies were developed.

Conclusions:

• HRA techniques provide a framework for surgeons to pinpoint error-prone surgical steps.
• Implementing HRA can significantly enhance surgical training programs.
• This systematic approach holds the potential to improve overall patient safety in surgical interventions.