Applying the human factors analysis and classification system to critical incident reports in anaesthesiology

Neuhaus, Christopher; Huck, Matthias; Hofmann, G.; St.Pierre, Michael; Weigand, Markus; Lichtenstern, Christoph

doi:10.1111/aas.13213

Cited by 21 publications

(18 citation statements)

References 47 publications

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“… 11 40 ClassIntra can help evaluate the origin of the complications during the surgical procedure, providing more granularity to the complication profile for each procedure or surgical unit. Also, ClassIntra can be used in critical incidence reporting systems, 41 for measuring individual performance in educational settings and system performance for benchmarking by institutions, and for outcome research. Future implementation studies should evaluate this tool in daily clinical practice for risk stratification of postoperative care or for planning resources and hospital capacities, in view of the increase in postoperative length of stay with the increasing severity of the ClassIntra grade.…”

Section: Discussionmentioning

confidence: 99%

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Dell-Kuster

Gomes

Gawria

et al. 2020

BMJ

138

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Objective To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. Design International, multicentre cohort study. Setting 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. Participants The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. Main outcome measures Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. Results Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). Conclusions ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. Trial registration ClinicalTrials.gov NCT03009929 .

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Section: Discussionmentioning

confidence: 99%

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Dell-Kuster

Gomes

Gawria

et al. 2020

BMJ

138

View full text Add to dashboard Cite

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“…Successful teamwork and communication is paramount to patient safety 1–3. Communication, specifically closed-loop, is the focus of healthcare institutions nationwide to improve patient safety 1.…”

Section: Discussionmentioning

confidence: 99%

“…Effective teamwork and communication are cornerstones of patient safety in healthcare 1–3. Communication failure is the third most common root cause of incident reports in emergency medicine (EM) and teamwork failure including communication errors are main factors in medical errors across specialties 4 5.…”

Section: Introductionmentioning

confidence: 99%

“…Communication failure is the third most common root cause of incident reports in emergency medicine (EM) and teamwork failure including communication errors are main factors in medical errors across specialties 4 5. Ineffective and inadequate communication among a healthcare team is the main aetiology of unsafe acts found in anaesthesia critical incidents 2. All healthcare teams, regardless of experience, require deliberate communication strategies to perform effectively in crisis situations 6.…”

Section: Introductionmentioning

confidence: 99%

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Advanced closed-loop communication training: the blindfolded resuscitation

Hughes

Cahir

et al. 2019

BMJ STEL

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Closed-loop communication (CLC) improves task efficiency and decreases medical errors; however, limited literature on strategies to improve real-time use exist. The primary objective was whether blindfolding a resuscitation leader was effective to improve crisis resource management (CRM) skills, as measured by increased frequency of CLC. Secondary objectives included whether blindfolding affected overall CRM performance or perceived task load. Participants included emergency medicine (EM) or EM/paediatric dual resident physicians. Participants completed presurveys, were block randomised into intervention (blindfolded) or control groups, lead both adult and paediatric resuscitations and completed postsurveys before debriefing. Video recordings of the simulations were reviewed by simulation fellowship-trained EM physicians and rated using the Ottawa CRM Global Rating Scale (GRS). Frequency of CLC was assessed by one rater via video review. Summary statistics were performed. Intraclass correlation coefficient was calculated. Data were analysed using R program for analysis of variance and regression analysis. There were no significant differences between intervention and control groups in any Ottawa CRM GRS category. Postgraduate year (PGY) significantly impacts all Ottawa GRS categories. Frequency of CLC use significantly increased in the blindfolded group (31.7, 95% CI 29.34 to 34.1) vs the non-blindfolded group (24.6, 95% CI 21.5 to 27.7). Participant’s self-rated perceived NASA Task Load Index scores demonstrated no difference between intervention and control groups via a Wilcoxon rank sum test. Blindfolding the resuscitation leader significantly increases frequency of CLC. The blindfold code training exercise is an advanced technique that may increase the use of CLC.

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“…The reason or Swiss chess model is widely applied for organizational decision-making in safety-critical systems. Notably, the involvement of human factors in accidents are investigated in-depth and documented; researchers like Neuhaus et al [21] and Wahab et al [22] have used this model for analyzing human behavior during critical incidents, even attempting to combine it with a BN (Bayesian network) model for taking preventive measures. The detection of individual causes from a complete incident scenario presents a complex analysis; furthermore, the chronological relationship between causes should be tracked.…”

Section: Literature Overview Of Aviation Safety Analysismentioning

confidence: 99%

A Case Study of Fishbone Sequential Diagram Application and ADREP Taxonomy Codification in Conventional ATM Incident Investigation

et al. 2019

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This paper aims to present the application of a fishbone sequential diagram in air traffic management (ATM) incident investigations performing as a key connection between safety occurrence analysis methodology (SOAM) and accident/incident data reporting (ADREP) approaches. SOAM analysis is focused on organizational cause detection; nevertheless, this detection of individual causes from a complete incident scenario presents a complex analysis, and even more, the chronological relationship between causes, which is lacking in SOAM, should be tracked for post-investigation analysis. The conventional fishbone diagram is useful for failure cause classification; however, we consider that this technique can also show its potential to establish temporal dependencies between causes, which are categorized and registered with ADREP taxonomy for future database creation. A loss of separation incident that occurred in the Edmonton area (Canada) is used as a case study to illustrate this methodology as well as the whole analysis process.

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Applying the human factors analysis and classification system to critical incident reports in anaesthesiology

Cited by 21 publications

References 47 publications

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Advanced closed-loop communication training: the blindfolded resuscitation

A Case Study of Fishbone Sequential Diagram Application and ADREP Taxonomy Codification in Conventional ATM Incident Investigation

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