30 de agosto de 2011

Artigo: Human Factors Research in Anesthesia Patient Safety: Techniques to Elucidate Factors Affecting Clinical Task Performance and Decision Making

Matthew B Weinger and Jason Slagle

JAMIA 2002 9: S58-S63

ABSTRACT
Patient safety has become a major public concern. Human factors research in other high-risk fields has demonstrated how rigorous study of factors that affect job performance can lead to improved outcome and reduced errors after evidence-based redesign of tasks or systems. These techniques have increasingly been applied to the anesthesia work environment. This paper describes data obtained recently using task analysis and workload assessment during actual patient care and the use of cognitive task analysis to study clinical decision making. A novel concept of “non-routine events” is introduced and pilot data are presented. The results support the assertion that human factors research can make important contributions to patient safety. Information technologies play a key role in these efforts.

INTRODUCTION
In order to improve patient safety, it is critical to understand how clinical systems actually work, what factors make them work well (or not so well), and why adverse events occur. It is particularly important to elucidate the role clinicians play in medical system safety. Given the complexity of clinical processes and the large number of interdependent mediating variables, these types of questions may not be amenable to traditional empirical experimentation. In complex high-risk systems it is highly undesirable to wait for a serious accident to happen before analyzing a system’s safety attributes. Thus, non-medical domains such as nuclear power and aviation have employed human factors techniques to extract detailed information about system performance and risks to safety. We have adapted this approach to medicine, using anesthesia as the initial test bed.

The Anesthesia Work Domain
Anesthesiologists, like surgeons and emergency room physicians, work in a complex, rapidly changing, time-constrained and stressful work environment. The anesthesia domain is in many ways similar to aircraft cockpits, air traffic control rooms, and combat information centers where effective performance demands expert knowledge, appropriate problem-solving strategies, and fine motor skills. The safe administration of anesthesia requires vigilance (e.g., etection of changes in patient condition), time-sharing among multiple tasks, and the ability to rapidly make decisions and take actions. The anesthesiologist views his/her task as managing a single highly interactive system composed of the patient, clinical equipment, surgeons, other operating room (OR) personnel, and the broader OR environment. Primary goals include protecting the patient from harm and facilitating surgery. Intraoperative anesthesia care is divided into induction, maintenance (when surgery occurs), and emergence.


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