Original articleCardiovascularApplication of the Human Factors Analysis and Classification System Methodology to the Cardiovascular Surgery Operating Room
Section snippets
Human Factors Model
Reason’s model of accident causation provides a theoretical framework that dissects the potential etiology of errors. The theory explains that accidents are caused by active failures (decisions performed by individuals at the delivery end of a system) and latent failures, which are a result of deficiencies in the organizational and management levels of a system. Latent failures predispose a system to error and may result in adverse events if many deficiencies are present within the levels of an
Results
Thirty-three males and 35 females were interviewed: 16 cardiac anesthesiologists-CRNAs, 13 monitor technicians, 11 RNs, 10 CSTs, 7 perfusionists, 4 residents, 4 senior cardiac surgeons, and 3 SAs. The mean age of the participants was 41 ± 11 years with 12.27 ± 10 years of experience.
The mean composite scores for the 68 participants are shown in Figure 2. Each of the four sections represent the four main human factor levels according to the HFACS model, and bars within each human factor level
Comment
The principle finding of this study is that HFACS (a classification system that has provided a successful interface to scientifically quantify the role of human factors in error creation) can be applied to the cardiovascular surgery OR in a comprehensive and global way, aimed at understanding the interplay of human factors in the immediate OR environment and the organizational structure. We applied and adapted HFACS by compiling factors discovered in previous studies known to affect patient
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Recipient of the 2006 Southern Thoracic Surgical Association President’s Award.