A Comparison of the Bow-Tie and STAMP Approaches to Reduce the Risk of Surgical Instrument Retention

Although relatively rare, surgical instrument retention inside a patient following Central Venous Catheterisation still presents a significant risk. The research presented here compared two approaches to help reduce retention risk: Bow-Tie Analysis and Systems- Theoretic Accident Model and Processes. Each method was undertaken separately and then the results of the two approaches were compared and combined. Both approaches produced beneficial results that added to existing domain knowledge, and a combination of the two methods was found to be beneficial. For example, the bow-tie analysis gave an overview of which activities keep controls working and who is responsible for each control, and the Systems-Theoretic Accident Model and Processes revealed the safety constraints that were not enforced by the supervisor of the controlled process. Such two-way feedback between both methods is potentially helpful for improving patient safety. Further methodology ideas to minimise surgical instrument retention risks are also described.This research was part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC EoE) at Cambridge and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Additional funding was provided by Cambridge University Hospitals NHS Foundation Trust. Cambridge University Hospitals NHS Foundation Trus

Psychological road audits: background, development and initial findings

Background: Road safety audits are becoming increasingly important around the world. They are often used to assess a new road before it is opened to the public, or to audit an existing highway. Aims: Whilst traditional road audits are of critical importance, it is hypothesized that a driver-centred approach by means of ‘psychological road audits’ could be beneficial for the safe road design process. The aim of this ongoing research is to develop a psychological road auditing process. Method: The methodology being developed currently consists of three main components. Firstly, a naturalistic driving study, in which participants drive along the road being audited. Secondly, experimenters perform an analysis of the main driving tasks: these are decomposed into sub-tasks. Finally, a driver-centred design workshop based on the tasks decomposed in component 2; this identifies risks for each sub-task by means of a participatory ergonomics process, current controls employed are noted, road design deficiencies are identified and user-centred design improvements are developed. Results: The project is a new Australian-Spanish-UK collaboration. For the naturalistic driving study component, initial data have been collected using a newly-opened highway in Granada, Spain. This road had a mixture of driving tasks, such as intersections and multi-lanes, plus has a comparatively high accident rate. To date, a range of experienced and novice drivers have driven the 10km route and had their verbal responses recorded. For the task analysis and driver-centred design workshop components, the driving task of ‘approaching an intersection’ was first decomposed into sub-tasks and then used as the subject matter for the safe design workshop. This revealed many potential road design deficiencies and suggestions for improvement. Conclusions: This research is still in its early stages. However, the approach used here, of providing a structured means of driver-centred safe highway design is producing potentially valuable results

The effect of distractions in the operating room during endourological procedures

Contains fulltext : 98421.pdf (publisher's version ) (Closed access)BACKGROUND: Professionals working in the operating room (OR) are subject to various distractions that can be detrimental to their task performance and the quality of their work. This study aimed to quantify the frequency, nature, and effect on performance of (potentially) distracting events occurring during endourological procedures and additionally explored urologists' and residents' perspectives on experienced ill effects due to distracting factors. METHODS: First, observational data were collected prospectively during endourological procedures in one OR of a teaching hospital. A seven-point ordinal scale was used to measure the level of observed interference with the main task of the surgical team. Second, semistructured interviews were conducted with eight urologists and seven urology residents in two hospitals to obtain their perspectives on the impact of distracting factors. RESULTS: Seventy-eight procedures were observed. A median of 20 distracting events occurred per procedure, which corresponds to an overall rate of one distracting event every 1.8 min. Equipment problems and procedure-related and medically irrelevant communication were the most frequently observed causes of interruptions and identified as the most distracting factors in the interviews. Occurrence of distracting factors in difficult situations requiring high levels of concentration was perceived by all interviewees as disturbing and negatively impacting performance. The majority of interviewees (13/15) thought distracting factors impacted more strongly on residents' compared to urologists' performance due to their different levels of experience. CONCLUSION: Distracting events occur frequently in the OR. Equipment problems and communication, the latter both procedure-related and medically irrelevant, have the largest impact on the sterile team and regularly interrupt procedures. Distracting stimuli can influence performance negatively and should therefore be minimized. Further research is required to determine the direct effect of distraction on patient safety

Assessing the visual demand from in-vehicle information systems by means of the occlusion technique: the effects of participant age

Occlusion is a measurement technique for assessing the visual demand and interruptability of in-vehicle information system (IVIS) tasks using a means for intermittent viewing of the IVIS displays/controls. Testing the visual demand of IVIS tasks using occlusion is gaining international support, largely due to it being a relatively simple method to use. Although an ISO occlusion standard has been published, some important issues remain; these include developing a robust and fully detailed measurement protocol. The age of participants is an important individual difference potentially affecting the validity and reliability of results from occlusion. To develop an effective protocol, the age ranges of participants need to be specified; otherwise experimenters undertaking measurements with varying age samples for the same systems/tasks may come to different conclusions. To assess the impact of age on occlusion task performance, 60 participants in various age ranges were tested on four different IVIS tasks. The results showed age-related differences; in particular, the older participants showed a greater spread of measurements. Excluding the issues of representative samples, the results imply that purely to obtain minimal inter-subject variability an occlusion measurement should use younger/middle-aged participants only

The Operability and Maintainability Analysis Technique: Integrating task and risk analysis in the Safe Design of industrial equipment

There has been increasing calls for mining equipment manufacturers to include Safe Design principles in their design processes. However, despite this demand, there has been no clear tool that mining manufactures and sites have agreed on as appropriate. This paper details the development and trial of the Operability and Maintainability Analysis Technique (OMAT) designed for this purpose. The tool was intentionally kept simple, combining qualitative risk management and task analysis in a participative ergonomics-style approach. It was found to be effective in identifying issues related to access and egress off mobile equipment and to suggest designs for these issues. In the future the tool will be further trialled with manufacturers

Defining criteria for the functional assessment of driving

Given the growing number of older drivers, accurate functional assessment of fitness to drive is becoming increasingly important. This paper describes work to define appropriate thresholds for cognitive, perceptual and physical tests on a static assessment rig (SAR). These rigs are used at Mobility Centres across the UK to provide measurements of driving characteristics as part of an assessment. However, criteria for decisions on functional fitness to drive have not been clearly defined or validated for SARs. A first study obtained normative data from the non-disabled driving population for each of the SAR tests. In the second study, disabled drivers were tested on the SAR; approximately half of these drivers used some type of steering, braking or accelerator adaptation. Following these two studies, criteria for the SAR tests were formalised and then validated by means of an experimental trial. Recommendations are made regarding the use of the SAR as part of the overall assessment process and for future research. 2010 Elsevier Ltd. All rights reserved

Collision avoidance and semi-automation in electric rope shovel operation

Background Electric rope shovels are large mobile excavators used in surface mining operations. The role of the shovel is to remove overburden from an underlying coal seam. Material excavated from the face is loaded into haul trucks for removal. Aims The objective of this research was to apply human factors techniques and principles to the evaluation and iterative design of load assistance and collision avoidance technologies for electric rope shovels. Methods Following observations, interviews and technical data reviews, a comprehensive hierarchical task analysis for shovel operation was developed. The human reliability technique 'HEART' was used to examine where the shovel operation task could fail, and hence where there was most need for technology to support the shovel operator. The resultant needs analysis was then compared to the capabilities of the technologies under development. Results The HEART revealed task difficulties at several points of the operation cycle, and the technologies under development offer a good fit to operator needs. The modelling capabilities of the technology can be exploited to provide a shared in-cabin display, depicting the position of the truck relative to the shovel and an optimum 'loading zone'. Conclusions Semi-automation and collision avoidance technologies under development have the potential to improve productivity and safety in electric rope shovel operation. The user-centred approach employed by the research is proving useful for the design new mining technologies, and further work will explore deployment and operator acceptance issues with a similar approach

Safe design of mobile construction and mining equipment

A design review of current mobile construction and mining equipment was undertaken using operator interviews, observations, an ergonomics audit checklist and a safe design workshop. The purpose was to identify any major ergonomics, usability or safety deficiencies associated with the equipment thatmay be considered in future design changes. Operators with different experience levels (novice, intermediate and expert) were the participants. This paper summarises the methods used and then outlines the key findings emerging, these include issues with the design of the cab workspace and the operator interface. The benefit of using operator-centred approaches for potentially improving the safe design of mobile construction and mining equipment is highlighted