Suther, Thomas

Objective: Design a protocol for conducting preoperative briefings within the context of cardiovascular surgery. Method: A combined questionnaire and semi-structured focus group approach involving four subspecialties of surgical staff (n = 47) was conducted to gather information concerning (1) attitudes towards preoperative briefings, (2) logistical issues related to the conduct and content of briefings and (3) potential barriers that might impede implementation. Results: Analyses revealed consensus among surgical staff concerning briefing benefits (majority were very positive), duration (< 10 min), location (in the OR), content (procedure, patient, and equipment issues) and potential barriers (staff availability, attitudes, case scheduling, and lack of resources). Differences in opinions arose concerning timing of the brief (e.g., before vs. after patient enters OR) and the role of key participants. Discussion: A prototype checklist for conducting preoperative briefings was developed based on these results. Additional research is needed to implement and validate its effectiveness.

Cardiopulmonary bypass machines (CBM's), first developed in 1953, are commonly used during heart surgery to oxygenate blood and circulate it throughout the body while the heart is stopped. Although several advances have occurred in the engineering of perfusion pumps, the interface design of CBM's has not changed appreciably for several decades. The growing awareness of human error in medicine has highlighted the role that poorly designed medical devices can play in producing errors that cause patient harm. The purpose of this study, therefore, was to identify issues related to CBM design that may predispose surgical teams to make errors. The study utilized multiple research methods including observations, heuristic evaluations, structured interviews and usability assessments. Results revealed several fundamental design problems associated CBM displays, controls, alarms, and component integration, as well as communication and procedural issues. These data provide valuable information for redesigning CBM's to reduce errors and improve patient safety.