Corbett Mel, O'Connor Paul, Byrne Dara, Thornton Mona, Keogh Ivan
Department of Otorhinolaryngology Head and Neck Surgery University Hospital Galway.
Laryngoscope Investig Otolaryngol. 2018 Nov 28;4(1):5-12. doi: 10.1002/lio2.220. eCollection 2019 Feb.
To develop a hierarchical task listing of steps required to perform successful Functional Endoscopic Sinus Surgery (FESS). To complete a technical and human factor analysis of tasks resulting in the identification of errors, frequency of occurrence, severity, and reduction through remediation.
A triangulation of methods was used in order to derive the steps required to complete a FESS: 1) a literature review was carried out of published descriptions of FESS techniques; 2) observations of three FESS; 3) interviews with surgeons on FESS techniques. Data sets were combined to develop a task analysis of a correct approach to conducting FESS. A review by 12 surgeons, and observation of 25 FESS resulted in refinement of the task analysis. With input from five consultant surgeons and one consultant anesthetist, a Systematic Human Error Reduction and Prediction Approach (SHERPA) was used to identify the risks and mitigating steps in FESS.
Ten tasks and 49 subtasks required for a correct approach to completing FESS were identified based on literature review and expert consensus. A risk score for each subtask was calculated from a suitable risk matrix. Risk reduction methods at each subtask were detailed. High-scoring subtasks were evaluated and varying strategies examined to reduce the likelihood and mitigate the impact of error. The study demonstrates the usefulness of the HTA and SHERPA approach in standardization and optimization of clinical practice in order to improve patient safety.
Hierarchical Task Analysis and SHERPA are valuable tools to deconstruct expert performance and to highlight potential errors in FESS. The HTA and SHERPA approach to surgical procedures are useful learning and assessment tools for novice surgeons. The information derived offers the opportunity to improve surgical training and enhance patient safety by identifying high-risk steps in the procedure, and how risk can be mitigated.
2c Outcomes Research.
制定成功实施功能性内镜鼻窦手术（FESS）所需步骤的分层任务清单。对任务进行技术和人为因素分析，以确定错误、发生频率、严重程度，并通过纠正措施减少错误。
采用三角测量法得出完成FESS所需的步骤：1）对已发表的FESS技术描述进行文献综述；2）观察三台FESS手术；3）就FESS技术采访外科医生。合并数据集以开展FESS正确实施方法的任务分析。12位外科医生进行的审查以及对25台FESS手术的观察使任务分析得到完善。在五位顾问外科医生和一位顾问麻醉师的参与下，采用系统的人为错误减少与预测方法（SHERPA）来识别FESS中的风险及缓解措施。
基于文献综述和专家共识，确定了正确完成FESS所需的10项任务和49项子任务。根据合适的风险矩阵计算每个子任务的风险评分。详细说明了每个子任务的风险降低方法。对高风险子任务进行评估，并研究不同策略以降低错误发生的可能性并减轻其影响。该研究证明了分层任务分析（HTA）和SHERPA方法在临床实践标准化和优化以提高患者安全性方面的有用性。
分层任务分析和SHERPA是解构专家操作并突出FESS中潜在错误的宝贵工具。HTA和SHERPA手术程序方法是新手外科医生有用的学习和评估工具。所获得的信息通过识别手术过程中的高风险步骤以及如何降低风险，为改进外科培训和提高患者安全性提供了机会。
2c结果研究。
