Designing a chest tube checklist using a multidimensional human factor approach: a hierarchical task analysis, a...

Area of Science:

• Medical Procedures
• Patient Safety
• Human Factors Engineering

Background:

• Chest tube insertion is a common procedure with complication rates up to 30%, impacting patient outcomes.
• Checklists are effective in reducing complications in medical procedures, but development guidance is lacking for chest tubes.
• A structured guide for analyzing and designing a chest tube procedure checklist has not been published.

Purpose of the Study:

• To introduce a structured design for a Chest Tube Checklist.
• To analyze chest tube insertion complications using human factor analysis tools.
• To provide a foundation for developing effective checklists for this procedure.

Main Methods:

• Multifactor analysis including Hierarchical Task Analysis, Failure Mode and Effective Analysis (FMEA), and Bow Tie analysis.
• Data collection via workshop and review of published literature on chest tube complications.
• Risk assessment focusing on identifying failure modes and their contributing factors.

Main Results:

• FMEA identified high-risk priority numbers (RPNs) for 'malposition of chest tube' (147 RPNs) and 'lack of sterility' (100 RPNs).
• Analysis highlighted the critical role of indication, preparation, and equipment in risk assessment and failure prevention.
• Bow Tie analysis detailed contributing factors, preventative controls, recovery barriers, and consequences for key failure modes.

Conclusions:

• Human factor analysis tools are effective for analyzing procedure complications and their root causes.
• A Chest Tube Checklist was designed based on the findings of the human factor analysis.
• Further research is needed to demonstrate the clinical effectiveness of the developed checklist.