Critical tasks and errors associated with intercostal chest drain insertion.

Area of Science:

• Emergency Medicine
• Surgical Procedures
• Patient Safety

Background:

• Intercostal chest drain insertion is a common medical procedure.
• Potential for critical errors exists during this invasive intervention.
• Enhanced procedural guidelines are needed to improve task performance and training.

Purpose of the Study:

• To identify critical tasks and associated errors in intercostal chest drain insertion.
• To develop enhanced procedural guidelines for improved task performance and training.
• To evaluate the criticality of identified errors.

Main Methods:

• Hierarchical task analysis to identify procedural steps.
• Systematic Human Error Reduction and Prediction Approach (SHERPA) to classify errors.
• Failure Modes, Effects, and Criticality Analysis (FMECA) to rank error criticality.

Main Results:

• 13 tasks and 61 sub-tasks identified, resulting in 86 potential errors.
• Errors classified into action, checking, and selection categories.
• Highest criticality error: incorrect identification of the insertion point (below the fifth intercostal space).
• Top-ranked errors focused on correct site identification within the safe triangle.

Conclusions:

• Critical tasks and errors in chest drain insertion were identified and evaluated.
• Accurate identification of a safe insertion point is the most critical task.
• Findings support the development of targeted procedural guidelines and training interventions to mitigate risks.