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Managing human factors in the assembly of the paediatric bronchoscope.

ABSTRACT: Foreign body aspiration in children is a life threatening event and prompt bronchoscopy and extraction is essential for their survival. During a recent paediatric airway emergency at Torbay hospital, Devon, the theatre staff were unable to assemble the paediatric bronchoscope. We therefore investigated methods to improve the efficiency and timeliness of the assembly of the paediatric bronchoscope. To assess the current problem we asked ten theatre staff at random to assemble the paediatric bronchoscope. 70% of the staff were not able to assemble the paediatric bronchoscope. A prompt poster was developed as a visual aid to help demonstrate how to assemble the paediatric bronchoscope. Another ten theatre staff were asked to assemble the paediatric bronchoscope. Now all of the staff were able to assemble the paediatric bronchoscope. The prompt poster enabled all the theatre staff tested to correctly assemble the paediatric bronchoscope and the average time taken was reduced. To further develop the service mandatory training sessions have been arranged to help theatre staff remain confident and continue to develop their skills and knowledge.

SUBMITTER: Saxby C

PROVIDER: S-EPMC4663814 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Managing human factors in the assembly of the paediatric bronchoscope.

Saxby Clair C Williams Richard R

BMJ quality improvement reports 20140103 2

Foreign body aspiration in children is a life threatening event and prompt bronchoscopy and extraction is essential for their survival. During a recent paediatric airway emergency at Torbay hospital, Devon, the theatre staff were unable to assemble the paediatric bronchoscope. We therefore investigated methods to improve the efficiency and timeliness of the assembly of the paediatric bronchoscope. To assess the current problem we asked ten theatre staff at random to assemble the paediatric bronc ...[more]

PMID: 26734233

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Project description:BackgroundAdolescent obesity epidemic is one of the major health priorities as it tracks into adult life. There is widespread need for new creative strategies and lifestyle programs. This study was designed to investigate the possible impact of including peers on the weight management program and assess the long-run adherence to behaviour change, with a potential positive impact on body mass index, body composition, and physical activity. Peer influence is major at this age and it is expected that adolescents will be better motivated and engaged in the behaviour changes when they are accompanied by their friends.Methods/designThe study is a non-randomised, non-blinded controlled trial, including two groups: 1) Comparison group (n = 35), which will receive a 12 month standard treatment at the hospital setting plus a weekly interactive and physical activity session; 2) Experimental group (n = 99), which will receive the standardized treatment at the hospital plus a weekly session together with a peer of their choice. The sample size calculations for the primary outcomes showed that we will have power to detect effect sizes of 0.25. Measures include: a) Dual-energy x-ray absorptiometry (for body composition assessment); b) Anthropometric evaluations; c) Assessment of physical activity levels by accelerometers; d) Psychosocial mediators (motivation and peer support) assessed with a package of psychometric questionnaires; and e) Outcomes (quality of life and well-being).DiscussionAdolescence is a crucial period for the development of a healthy lifestyle, especially among those who reach this age with an obesity condition. Obesity management programs directed to adolescents are often an adopted version of programs developed for children, most of them with a strong focus on the family, or an adopted version of adult programs, not recognizing the specificities of this age group. This study is designed taking into account the unique characteristics of this life-cycle stage, with the main objective of testing an innovative treatment for adolescent obesity.Trial registrationThis trial is registered in the clinicaltrials.gov with the number NCT02024061.

Project description:BackgroundTeaching and assessing clinical procedures requires a clear delineation of the individual steps required to successfully complete the procedure. For decades, human reliability analysis (HRA) has been used to identify the steps required to complete technical procedures in higher risk industries. However, the use of HRA is uncommon in healthcare. HRA has great potential supporting simulation-based education (SBE) in two ways: (1) to support training through the identification of the steps required to complete a clinical procedure; and (2) to support assessment by providing a framework for evaluating performance of a clinical procedure. The goal of this study was to use HRA to identify the steps (and the risk associated with each of these steps) required to complete a bronchoscope-assisted percutaneous dilatational tracheostomy (BPDT). BPDT is a potentially high-risk minimally invasive procedure used to facilitate tracheostomy placement at the bedside or in the operating theatre.MethodsThe subgoals, or steps, required to complete the BPDT procedure were identified using hierarchical task analysis. The Systematic Human Error Reduction and Prediction Approach (SHERPA) was then used to identify potential human errors at each subgoal, the level of risk and how these potential errors could be prevented.ResultsThe BPDT procedure was broken down into 395 subgoals, of which 18% were determined to be of high-risk. The most commonly identified remediation strategies for reducing the risk of the procedure included: checklist implementation and audit, statutory and mandatory training modules, simulation training, consultant involvement in all procedures, and fostering a safety-focused hospital culture.ConclusionThis study provides an approach for how to systematically identify the steps required to complete a clinical procedure for both training and assessment. An understanding of these steps is the foundation of SBE. HRA can identify 'a correct way' for teaching learners how to complete a technical procedure, and support teachers to give systematic and structured feedback on performance.

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Managing human factors in the assembly of the paediatric bronchoscope.

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Managing human factors in the assembly of the paediatric bronchoscope.

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