* Doctoral Candidate, ‖ Associate Professor, Department of Industrial Engineering, Clemson University, Clemson, South Carolina. † Associate Professor, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, and Adjunct Associate Professor, Department of Industrial Engineering, Clemson University. ‡ Graduate Student, § Professor/Director, Graduate Program in Architecture and Health, School of Architecture, Clemson University. # Professor and Chair, Department of Industrial Engineering, Clemson University, and Human Factors and Systems, Embry-Riddle Aeronautical University, Daytona Beach, Florida. †† Professor and Chairman, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina.
Anesthesiology. 2013 Nov;119(5):1066-77. doi: 10.1097/ALN.0b013e31829f68cf.
Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR).
Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized.
The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%).
By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.
人因工程学允许对众多高风险行业中的不良事件进行系统评估。本研究旨在开发一种用于识别和分类心脏手术室（OR）中流程中断的初始方法。
两名具有人因工作流程中断专业知识的工业工程师观察了 10 例心脏手术，从患者进入 OR 到离开 ICU 的时间。每个中断都在 OR 套房的建筑布局上进行了详细记录，并在手术的每个阶段（术前[切口前]、术中[切口至皮肤缝合]和术后[皮肤缝合至患者离开 OR]）进行时间标记，以将两个观察者之间的流程中断同步。然后对这些中断进行分类。
两名观察者共进行了 1158 次观察。消除重复观察后，共剩余 1080 次观察进行分析。这些中断分为沟通、可用性、物理布局、环境危害、一般中断和设备故障等六个类别。它们进一步细分为 33 个子类。最常见的中断与 OR 布局和设计有关（33%）。
通过使用详细的建筑图纸，作者首次能够清楚地展示 OR 设计和设备布局对物理布局流程中断的独特作用。最重要的是，作者已经开发了一种强大的分类法来描述心脏 OR 中遇到的流程中断，可用于未来的研究和患者安全改进。
