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J Thorac Cardiovasc Surg 2000;119:661-672
© 2000 The American Association for Thoracic Surgery
LEAD ARTICLE |
From the Great Ormond Street Hospital for Children NHS Trust,a London, the Department of Statistical Science, University College,b London, Department of Psychology, and The University of Manchester,c United Kingdom.
This study was supported by a research grant (PG94166) from the British Heart Foundation.
Address for reprints: M. R. de Leval, MD, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Objective: To study the role of human factors on surgical outcomes, with a series of 243 arterial switch operations performed by 21 surgeons taken as a model.
Methods: The following data were collected: patient-specific and procedural variables, self-assessment questionnaires, and a written report from a human factors researcher who observed the operation. The relationship of patient-specific variables to outcomes (death and death and/or near miss) was used to develop a multivariable baseline model to analyze the role of human factors after adjustment for these variables.
Results: The overall mortality was 6.6% with 24.3% of cases resulting in death and death and/or near misses. The self-assessment questionnaires were found to be unhelpful. Major and minor human failures were extracted from the written report. Major negative events were potentially life-threatening failures, whereas minor events were failures that, in isolation, were not expected to have serious consequences. Major events were closely related to death (P < .001) and death and/or near misses (P < .001). Appropriate compensation, however, sharply reduced the risk of death (P = .003). The total number of minor events was also closely related to both death and death and/or near misses (P < .001).
Conclusion: The study highlights the role of human factors in negative surgical outcomes. Even in the most eventful circumstances, however, appropriate human factors defense mechanisms can lead to a successful outcome.
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