Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety
Objective To understand human factors (HF) contributing to disturbances during invasive cardiac procedures, including frequency and nature of distractions, and assessment of operator workload.Methods Single centre prospective observational evaluation of 194 cardiac procedures in three adult cardiac...
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doaj-63e80e24936a4815b99ca960a36f38242021-02-01T16:00:35ZengBMJ Publishing GroupOpen Heart2053-36242020-12-017210.1136/openhrt-2020-001260Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safetyAlex Hobson0Paul R Kalra1Kalaivani Mahadevan2Elena Cowan3Navneet Kalsi4Helena Bolam5Geraint Morton6Kaushik Guha7Peter A Brennan8Richard Arnett9Cardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKCardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKCardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKCardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKRoyal Hampshire County Hospital, Winchester, Hampshire, UKCardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKCardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKCardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKMaxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UKQuality Enhancement Office, Royal College of Surgeons in Ireland, Dublin, IrelandObjective To understand human factors (HF) contributing to disturbances during invasive cardiac procedures, including frequency and nature of distractions, and assessment of operator workload.Methods Single centre prospective observational evaluation of 194 cardiac procedures in three adult cardiac catheterisation laboratories over 6 weeks. A proforma including frequency, nature, magnitude and level of procedural risk at the time of each distraction/interruption was completed for each case. The primary operator completed a National Aeronautical and Space Administration (NASA) task load questionnaire rating mental/physical effort, level of frustration, time-urgency, and overall effort and performance.Results 264 distractions occurred in 106 (55%) out of 194 procedures observed; 80% were not relevant to the case being undertaken; 14% were urgent including discussions of potential ST-elevation myocardial infarction requiring emergency angioplasty. In procedures where distractions were observed, frequency per case ranged from 1 to 16 (mean 2.5, SD ±2.2); 43 were documented during high-risk stages of the procedure. Operator rating of NASA task load parameters demonstrated higher levels of mental and physical workload and effort during cases in which distractions occurred.Conclusions In this first description of HF in adult cardiac catheter laboratories, we found that fewer than half of all procedures were completed without interruption/distraction. The majority were unnecessary and without relation to the case or list. We propose the introduction of a ‘sterile cockpit’ environment within catheter laboratories, as adapted from aviation and used in surgical operating theatres, to minimise non-emergent interruptions and disturbances, to improve operator conditions and overall patient safety.https://openheart.bmj.com/content/7/2/e001260.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alex Hobson Paul R Kalra Kalaivani Mahadevan Elena Cowan Navneet Kalsi Helena Bolam Geraint Morton Kaushik Guha Peter A Brennan Richard Arnett |
spellingShingle |
Alex Hobson Paul R Kalra Kalaivani Mahadevan Elena Cowan Navneet Kalsi Helena Bolam Geraint Morton Kaushik Guha Peter A Brennan Richard Arnett Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety Open Heart |
author_facet |
Alex Hobson Paul R Kalra Kalaivani Mahadevan Elena Cowan Navneet Kalsi Helena Bolam Geraint Morton Kaushik Guha Peter A Brennan Richard Arnett |
author_sort |
Alex Hobson |
title |
Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety |
title_short |
Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety |
title_full |
Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety |
title_fullStr |
Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety |
title_full_unstemmed |
Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety |
title_sort |
distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety |
publisher |
BMJ Publishing Group |
series |
Open Heart |
issn |
2053-3624 |
publishDate |
2020-12-01 |
description |
Objective To understand human factors (HF) contributing to disturbances during invasive cardiac procedures, including frequency and nature of distractions, and assessment of operator workload.Methods Single centre prospective observational evaluation of 194 cardiac procedures in three adult cardiac catheterisation laboratories over 6 weeks. A proforma including frequency, nature, magnitude and level of procedural risk at the time of each distraction/interruption was completed for each case. The primary operator completed a National Aeronautical and Space Administration (NASA) task load questionnaire rating mental/physical effort, level of frustration, time-urgency, and overall effort and performance.Results 264 distractions occurred in 106 (55%) out of 194 procedures observed; 80% were not relevant to the case being undertaken; 14% were urgent including discussions of potential ST-elevation myocardial infarction requiring emergency angioplasty. In procedures where distractions were observed, frequency per case ranged from 1 to 16 (mean 2.5, SD ±2.2); 43 were documented during high-risk stages of the procedure. Operator rating of NASA task load parameters demonstrated higher levels of mental and physical workload and effort during cases in which distractions occurred.Conclusions In this first description of HF in adult cardiac catheter laboratories, we found that fewer than half of all procedures were completed without interruption/distraction. The majority were unnecessary and without relation to the case or list. We propose the introduction of a ‘sterile cockpit’ environment within catheter laboratories, as adapted from aviation and used in surgical operating theatres, to minimise non-emergent interruptions and disturbances, to improve operator conditions and overall patient safety. |
url |
https://openheart.bmj.com/content/7/2/e001260.full |
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