Mini-reviewHuman factors in resuscitation teaching
Introduction
Human factors are normally described in terms of patient safety and how safety can be improved if training is given. This paper aims to address how human factors might be taught within the context of resuscitation teaching.
Patient safety is increasingly recognised as a high priority for healthcare systems. Prevention of medical error includes identifying possible causes through reporting and analysis, and learning from mistakes previously made. Causative factors include medical complexity, system failures, and human factors.
The ‘Clinical Human Factors Group’1 has defined Human factors as “… all the things that make us different from logical, completely predictable machines, how we think and relate to other people, equipment and our environment. It is about how we perform in our roles and how we can optimise that performance to improve safety and efficiency. In simple terms it's the things that affect our personal performance” (Table 1).
There are numerous types of human error, ranging from a momentary lack of concentration to accidentally or deliberately taking short cuts. An example of the former may be a mistake in drug dosage caused by tiredness. People may also make mistakes if they are not well enough to work and health care workers often try and carry on through a sense of duty. The aviation industry has established processes in place to limit error due to human factors. In a similar way to the clinical ‘ABCDE’ approach on resuscitation courses, they use a daily check list (using the acronym ‘IM SAFE’) to determine whether or not someone is fit to work.2 This acronym could easily be adopted into medical practice.
At the other end of the scale, practitioners may make a deliberate choice to perform a task in a certain way believing they can perform something more efficiently using their method. An example in the emergency setting might be the insertion of a chest drain using a trochar.
Resuscitation training in the healthcare system has been established through life support courses since the 1960s. Numerous courses exist to train healthcare professionals in basic and advanced life support in patients ranging in age from newborn to adulthood. These courses are administered and quality assured by a range of organisations, including national and international resuscitation councils. The structure of the courses has traditionally focused on knowledge, clinical skills, processes and algorithms. Human factors have traditionally been poorly addressed within the mainstream life support courses. However, despite this, some of the courses are still seen as providing training in this area. An ethnographic study in 2005 showed that most of the consultants at the Royal London Hospital had no team leadership training other than the ATLS course.3
There is therefore a need to train the aspiring resuscitation team leader in human factors or non technical skills as well as the various clinical skills. As a result, the resuscitation councils of UK and Europe have introduced relevant chapters in their latest training manuals.
Section snippets
Methodology
Early studies explored non technical skills in cockpit resource management in the airline industry, which extended into crew resource management, and subsequently crisis resource management or non technical skills for anaesthesia in high fidelity settings.4 The authors chose to look to resuscitation and leadership to gain a more contemporary approach to human factor teaching. Earlier studies tended to focus on the airline industry and anaesthesia.
Medline was searched using MESH terms
Problems identified in resuscitation practice
Andersen et al.5 looked at errors related to cardiac arrest management reported to the Danish Patient Safety Database. There were four recurring themes: lack of good organisation 9%, equipment issues (lack of equipment 11% and malfunction of equipment 16%), inability to use equipment 5% and a lack of space to work safely 11%. The organisational problems related to team dynamics, in particular poor communication, unclear leadership, people interrupting one another and a lack of knowledge of
Discussion
The main focus of the life support courses to date has been to teach technical skills and learning process but this is changing with the introduction of human factors as a chapter in the recent international guidelines on resuscitation.31 This is only the first step however as the topics of team dynamics, stress, debriefing, and team conflict need to be further explored within the courses.
The experience of the European Trauma Course (ETC) is encouraging.32 The ETC is a three day advanced trauma
Conclusion
The attributes of human factors are now clear. Topics including team dynamics (leadership and membership/followership), stress, debriefing, and team conflict have been highlighted as areas needing significant improvement in resuscitation practice. There is a need to improve human factor training in resuscitation and, in particular, on life support courses.
We have outlined four potential areas where work could be done – e-learning/gaming, introduction to error and risk assessment, simulation,
Conflict of interest statement
No conflicts of interest to declare.
References (44)
- et al.
Critical incidents related to cardiac arrests reported to the Danish Patient Safety database
Resuscitation
(2010) - et al.
A multi-professional full scale simulation course in the recognition and management of deteriorating hospital patients
Resuscitation
(2009) - et al.
Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams
Resuscitation
(2010) - et al.
Junior physician skill and behaviour in resuscitation: a simulation study
Resuscitation
(2009) - et al.
Development of a formative assessment tool for measurement of performance in multi-professional resuscitation teams
Resuscitation
(2010) - et al.
Observation skill-based clinical assessment tool for resuscitation (OSCAR): development and validation
Resuscitation
(2011) - et al.
Rating emergency teamwork performance development of the team emergency assessment measure (TEAM)
Resuscitation
(2010) - et al.
Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study
Resuscitation
(2009) - et al.
Doing a good job and getting something good out of it: on stress and well-being in anaesthesia
British Journal of Anaesthesia
(2010) - et al.
Is the advanced trauma life support simulation exam more stressful than emergency department trauma care
Clinics
(2005)
Haemodynamic effects of mental stress during cardiac arrest simulation testing on advanced life support courses
Resuscitation
European resuscitation guidelines for resuscitation 2010. Section 1. Executive summary
Resuscitation
The European Trauma Course and the team approach, past, present and future
Resuscitation
The effect of pre-course learning prior to advance life support training: a randomised controlled trial
Resuscitation
Using e-learning for maintenance of ALS competence
Resuscitation
The culture of a trauma team in relation to human factors
Issues in Clinical Nursing
Integrating human factors into the medical curriculum
Medical Education
Leading teams
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