Military Operating Room of the Future
Abstract
In a variety of industrial settings, investigators have used insights from human factors research to optimize the flow of complex work by improving teamwork, technology, training levels or the general work environment. We are using the same methodology to identify and address "flow disruptions" in trauma care in an effort to decrease risk and adverse events. We are using two methods to identify deviations: (1) surveys and focus group interviews of experienced care givers (qualitative measures), and (2) direct observation of care progression by trained observers (quantitative measures). Survey results from 41 providers suggested positive attitudes to safety, with "speaking up" (71/100) and equipment (76/100) especially positive. Focus group interviews from 73 providers identified coordination (31%) and deviation from trauma protocol (20%) to be the primary sources of flow disruption. To date, observers have noted 278 flow disruptions in 12 cases and have established coordination between patient care teams (29%), patient-related delays (21%), communication (14%), and equipment issues (10%) to be the most common causes. The impact of observed flow disruptions was characterized as none to minimal (78%), moderate (14%), and full case cessation (1%), with the remainder categorized as unknown/missing. A sub-analysis of one operative case found 78 disruptions due to patient-related delays and coordination problems. In combination, these qualitative and quantitative assessments build a picture of the complexity of trauma care and a systemic predisposition to error that is richer and more representative than any single source of data. Adverse impact from "flow disruptions" were seen in 15% of observed cases. Appropriate human-centered systemic interventions to reduce flow disruptions during the trauma process may help identify delays, inefficiencies, and risks in patient care and improve trauma outcomes.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2011
- Accession Number
- ADA553413
Entities
People
- Bruce Gewertz
Organizations
- Cedars-Sinai Medical Center