Improve safety and efficiency in cardiac surgery

Under the management of Araz Abbas, PhD student and clinical perfusionist at the department of the cardiac thoracic surgery in Leiden University Medical Center (LUMC) in the Netherlands, a project has been started to enhance patient safety in cardiac surgery.


Interaction in cardiac surgical room

The cardiac surgical operating room is a complex environment in which highly trained personnel interact with each other using sophisticated equipment to provide care to patients with severe cardiac disease and significant comorbidities. Nonetheless, those highly skilled and dedicated personnel in cardiac surgical room are human and make mistakes. Gawande [1] and associates found that the incidence of surgical adverse events was 12% among cardiac surgery patients versus 3% in other surgical patients. 54% of the adverse were considered preventable. Preventable incidents are often not related to failure of technical skill neither training or lack of knowledge but represent cognitive and teamwork errors. 

operating room doctor

Nontechnical skills such as communication, cooperation and leadership are critical aspects of teamwork and limited nontechnical skills often underlie adverse events and errors. The communication failures occurred primarily between caregivers, which lead to breakdowns in teamwork. Subsequently these breakdowns lead to surgical flow disruption in the operating room and shows predication of surgical errors.


Developing a communication method

In the area of cardiac surgery, communication differs from other specializations. During cardiac surgery where the heart is stopped, the heart‐lung machine (HLM) is used to oxygenate and circulate blood through the body. The perfusionist operates the HLM. This is a critical part of the operation and communication between the surgeon, perfusionist and anaesthesiologist is very important and has been suggested as a critical issue in all aspects of human interaction during cardiac surgery. 

This human interaction is a human factor element that should be evaluated in the context of quality and patient safety in cardiac surgery, yet often seems to be one of the priority hazard themes and communication failures in cardiac surgery that can be associated with patient harm and poor outcomes. That is why communication during cardiac surgery is so important because it provides means to facilitate and enables the sequencing of actions to accomplish tasks required. 

Therefore, developing a communication method is indispensable. Without a scientific and validated method, it would be difficult to measure and to assess communication during cardiac surgery. In addition it will be difficult to develop appropriate team training to improve the communication. Data collection is essential in assessing communication and provides insights into perceptions and conditions that induce communication errors. MediaRecorder is used to make video recordings which will provide the needed input. The Observer XT supplies the analysis, identification and evaluation of the communication patterns and team performance.

[1] Gawande, A.A.; Thomas, E.J.; Zinner, M.J.; Brennan, T.A. (1992) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 1999; 126, 66–75.

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