Elsevier

Resuscitation

Volume 83, Issue 4, April 2012, Pages 423-427
Resuscitation

Mini-review
Human factors in resuscitation teaching

https://doi.org/10.1016/j.resuscitation.2011.11.001Get rights and content

Abstract

Introduction

There is an increasing interest in human factors within the healthcare environment reflecting the understanding of their impact on safety. The aim of this paper is to explore how human factors might be taught on resuscitation courses, and improve course outcomes in terms of improved mortality and morbidity for patients. The delivery of human factors training is important and this review explores the work that has been delivered already and areas for future research and teaching.

Method

Medline was searched using MESH terms Resuscitation as a Major concept and Patient or Leadership as core terms. The abstracts were read and 25 full length articles reviewed.

Results

Critical incident reporting has shown four recurring problems: lack of organisation at an arrest, lack of equipment, non functioning equipment, and obstructions preventing good care. Of these, the first relates directly to the concept of human factors. Team dynamics for both team membership and leadership, management of stress, conflict and the role of debriefing are highlighted. Possible strategies for teaching them are discussed.

Conclusions

Four strategies for improving human factors training are discussed: team dynamics (including team membership and leadership behaviour), the influence of stress, debriefing, and conflict within teams. This review illustrates how human factor training might be integrated further into life support training without jeopardising the core content and lengthening the courses.

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)

  • C. Sandroni et al.

    Haemodynamic effects of mental stress during cardiac arrest simulation testing on advanced life support courses

    Resuscitation

    (2005)
  • J.P. Nolan et al.

    European resuscitation guidelines for resuscitation 2010. Section 1. Executive summary

    Resuscitation

    (2010)
  • C. Lott et al.

    The European Trauma Course and the team approach, past, present and future

    Resuscitation

    (2009)
  • G.D. Perkins et al.

    The effect of pre-course learning prior to advance life support training: a randomised controlled trial

    Resuscitation

    (2010)
  • M.L. Jensen et al.

    Using e-learning for maintenance of ALS competence

    Resuscitation

    (2009)
  • Clinical Human Factors Group. www.chfg.org [accessed...
  • World Alliance for Patient Safety. http://whqlibdoc.who.int/publications/2011/9789241501958_eng.pdf [accessed...
  • E. Cole et al.

    The culture of a trauma team in relation to human factors

    Issues in Clinical Nursing

    (2006)
  • R.J. Glavin et al.

    Integrating human factors into the medical curriculum

    Medical Education

    (2003)
  • Resuscitation Council UK....
  • National Patient Safety Agency....
  • D. Pardey

    Leading teams

    (2004)
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