54 The frequency and impact of procedural distractions and interruptions in the adult cardiac catheterisation laboratory. (May 2019)

• Record Type: Journal Article
• Authors: Mahadevan, Kalaivani; Cowan, Elena; Kalsi, Navneet; Bolam, Helena; Morton, Geraint; Guha, Kaushik; Brennan, Peter; Kalra, Paul
• Is Part Of: Heart. Volume 105(2019)Supplement 6
• Page Start: A46
• Page End: A47
• Publication Date: 2019-05
• Subjects: Human Factors -- Cardiac Catheterisation Lab -- Procedural distractions; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2019-BCS.52
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Purpose: To understand factors contributing to disturbances during cardiac procedures, including frequency and nature of distractions, along with assessment of operator 'work-load' through NASA Task-load indices. Methods: A single centre prospective observational study was conducted on 194 consecutive patients undergoing cardiac procedures in 3 adult cardiac CL's over a period of 4 weeks. A distraction pro-forma was completed for each case by CL team members (predominantly physiologists), documenting procedural logistics and referring both to the level of risk of the procedure at that time (table 1 ) and frequency, nature and magnitude of each distraction/interruption (table 2 ). The primary operator completed a NASA Task-load questionnaire rating parameters to include mental and physical effort, level of frustration, time–urgency, and overall effort and performance on a scale of 1 – 21. Results: 264 distractions occurred in 106 procedures (55% of total); 80% were not relevant to the case being undertaken; 13% were due to emergencies occurring in the 'Hot- Lab' predominantly to discuss potential ST-elevation myocardial infarction requiring emergency angioplasty. Frequency of distractions per case ranged from 1 to 16, with an average of 2.5; 16% (n=43) of these were documented to occur during high-risk stages (categories 3 or 4) of the procedure. Operator rating of NASA task-load parameters demonstrated higher levels of 'mental' and 'physical' workload and 'effort' when distractions occurred (figure 1 ). Conclusion: In this first description of human factors in the adult cardiac CL we have shown that less than half of all procedures are completed without interruption/distraction. The vast majority of these are unnecessary and without relation to the case or list. We therefore propose the introduction of a 'sterile cockpit' environment in the CL, as has been adapted from the aviation industry within surgical operating theatres, to minimise non-emergent interruptions and disturbances, in an attempt to improve operator conditions and overall patient safety. Conflict of Interest: Nil