Article Text

Original research
Distractions in the cardiac catheterisation laboratory: impact for cardiologists and patient safety
  1. Kalaivani Mahadevan1,
  2. Elena Cowan1,
  3. Navneet Kalsi2,
  4. Helena Bolam1,
  5. Richard Arnett3,
  6. Alex Hobson1,
  7. Kaushik Guha1,
  8. Geraint Morton1,
  9. Peter A Brennan4,5 and
  10. Paul R Kalra1,5
  1. 1Cardiology Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  2. 2Royal Hampshire County Hospital, Winchester, Hampshire, UK
  3. 3Quality Enhancement Office, Royal College of Surgeons in Ireland, Dublin, Ireland
  4. 4Maxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  5. 5University of Portsmouth, Portsmouth, Hampshire, UK
  1. Correspondence to Dr Elena Cowan; cowan.elena{at}gmail.com

Abstract

Objective To understand human factors (HF) contributing to disturbances during invasive cardiac procedures, including frequency and nature of distractions, and assessment of operator workload.

Methods Single centre prospective observational evaluation of 194 cardiac procedures in three adult cardiac catheterisation laboratories over 6 weeks. A proforma including frequency, nature, magnitude and level of procedural risk at the time of each distraction/interruption was completed for each case. The primary operator completed a National Aeronautical and Space Administration (NASA) task load questionnaire rating mental/physical effort, level of frustration, time-urgency, and overall effort and performance.

Results 264 distractions occurred in 106 (55%) out of 194 procedures observed; 80% were not relevant to the case being undertaken; 14% were urgent including discussions of potential ST-elevation myocardial infarction requiring emergency angioplasty. In procedures where distractions were observed, frequency per case ranged from 1 to 16 (mean 2.5, SD ±2.2); 43 were documented during high-risk stages of the procedure. Operator rating of NASA task load parameters demonstrated higher levels of mental and physical workload and effort during cases in which distractions occurred.

Conclusions In this first description of HF in adult cardiac catheter laboratories, we found that fewer than half of all procedures were completed without interruption/distraction. The majority were unnecessary and without relation to the case or list. We propose the introduction of a ‘sterile cockpit’ environment within catheter laboratories, as adapted from aviation and used in surgical operating theatres, to minimise non-emergent interruptions and disturbances, to improve operator conditions and overall patient safety.

  • interventional cardiology
  • quality of care and outcomes
  • delivery of care
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Footnotes

  • Twitter @KVM83, @ElenaCowan_, @BrennanSurgeon

  • Contributors KM: data acquisition, analysis and interpretation, manuscript drafting and critical revision. EC: data analysis and interpretation, critical revision of manuscript. NK: study design. HB: data acquisition. RA: data analysis and interpretation, critical revision of manuscript. AH: data acquisition and interpretation, critical revision of manuscript. KG: data acquisition and interpretation, critical revision of manuscript. GM: data acquisition and interpretation, critical revision of manuscript. PAB: data interpretation, critical revision of manuscript. PRK: study conception and design, data acquisition and interpretation, critical revision of manuscript. All authors have contributed to the revision of manuscript and have accepted the final version. Guarantors: KM, PRK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This was a combined patient safety and service evaluation project without impact on standard patient care in accordance with the UK Policy Framework for Health and Social Care Research guidance, hence formal Research Ethic Committee approval and consent were not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

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