Development and Evaluation of an Observational Tool for Assessing Surgical Flow Disruptions and Their Impact on Surgical Performance
- 602 Downloads
Many researchers have previously explored the correlation between surgical flow disruptions and adverse events in cardiac surgery; however, there is no reliable tool to prospectively categorize surgical flow disruptions and the conditions that predispose a surgical team to adverse events.
Two independent raters of different medical and human factors expertise observed 12 cardiovascular operations and iteratively designed a surgical flow disruption tool (SFDT) to characterize surgical flow disruptions and the latent factors that contribute to adverse events. Categories to characterize surgical flow disruptions were created based on human factors models of human error. After the design period, both raters observed ten surgical cases using the tool to assess validity and inter-rater reliability.
Rating agreement (weighted kappa) for each category across the ten surgeries was moderate to very high, resulting in strong inter-rater reliability for each category on the surgical flow disruption tool. Use of the SFDT was simple and clear for observers of diverse backgrounds, including human factors experts and medical personnel.
This research depicts the development and utility of a tool to analyze surgical flow disruptions in the cardiovascular operating room with satisfactory inter-rater reliability. This tool is an important first step in systematically categorizing and measuring surgical flow disruptions and their impact on patient safety in the operating room.
KeywordsOperating Room Cardiovascular Surgery Surgical Team Kappa Score Flow Disruption
- 2.Committee on Quality of Health Care in America, Institute of Medicine (1999) Kohn LT, Corrigan JM, Donaldson MS (eds) To err is human: building a safer health system. Washington, DC: National Academy PressGoogle Scholar
- 5.Wiegmann DA, Shappell SA (2003) A human error approach to aviation accident analysis: the human factors analysis and classification system. Ashgate, Burlington, VTGoogle Scholar
- 6.Reason JT (1990) Human error. Cambridge University Press, Cambridge, EnglandGoogle Scholar
- 13.Altman DG (1991) Practical statistics for medical research. Chapman and Hall, LondonGoogle Scholar
- 14.MedCalc for Windows version 126.96.36.199. (2009) MedCalc Software, Mariakerke, BelgiumGoogle Scholar
- 16.Flin R, Martin L, Goeters K et al (2003) Development of the NOTECHS (non-technical skills) system for rating pilots’ CRM skills. Hum Fac Aero Safety 3:95–117Google Scholar
- 17.Helmreich RL, Roushee HC (1993) Why crew resource management? Empirical and theoretical bases of human factors training in aviation. In: Wiener E, Kanaki B, Helmreich R (eds) Cockpit resource management. Academic Press, San Diego, pp 3–45Google Scholar
- 26.O’Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, Nowicki ER, Levy DG, Tryzelaar JF, Hernandez F (1992) Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group. Circulation 85:2110–2118PubMedGoogle Scholar