The FOCUS Initiative Of The Society Of Cardiovascular Anesthesiologists (SCA) Foundation

Most of us go to hospitals when we, or those we love, are in dire need of medical help. Entering this high tech environment can be unnerving, but we maintain high levels of trust and hope. Patients expect to get positive results from highly trained professional care givers. Fortunately, advances in medicine over the past 50 years make it possible for physicians and their teams to meet our expectations. An astonishing array of critical illnesses, from heart failure to cancer can now be treated. These advances require increasingly complex training and technical skill.

The aging population of the United States is increasing at a rapid rate. Specialists are called upon to treat growing numbers of critically ill patients. Regrettably, this can bring case overload and long hours of multitasking for health care providers, including cardiac anesthesiologists. Fatigue and stress take their toll. Given the need to remember complex treatment options in the technically demanding environment of the operating room (OR), it is easy to get things wrong.

Human error in health care delivery leads to 44,000-98,000 deaths per year in the United States alone.1 The World Health Organization (WHO) sees human error in the delivery of medical care as a major problem for industrialized and emerging nations alike. As a result, they have made the reduction of human error a priority in campaigns for the next five years.

Raising the Bar on Patient Safety

The Society of Cardiovascular Anesthesiologist’s (SCA) FOCUS initiative is a complementary and cooperative effort designed to raise the bar for patient safety through human factors engineering. To meet the highly technical demands of the modern operating room (OR), professionals must have advanced training and excellent communication skills. Successful cardiovascular OR teams work through clear communication, rehearsed interactions, and painstaking accuracy to build harmony. Unfortunately, not all institutions are able to field such winning teams.

[In] the operating room....complexity is manifest in the patient and treatment protocol, as well as the high level of technology and coordination required to effectively manage rapidly changing conditions. Several studies [have analyzed]...complex heath care settings, such as the intensive care unit, OR, and emergency room, as systems and how interactions between components influence performance and patient safety....A recent review article by Vincent et al illustrates the need for further prospective system analyses to identify features and processes of care that can be used to improve patient safety and quality of care.

Systems analysis – the study of the organization, interactions and interdependencies of people, information, resources, equipment, and procedures as they work toward a common goal.
Human factors engineering – the study and redesign of environments and processes to ensure safer, more effective, and more efficient use by humans.

Airplane safety in the OR

While an unconventional approach to clinical research, studies in industrial, aviation, and other high-risk domains have led to major system redesigns and improvements in safety and performance. The SCA recognizes an excellent opportunity for cross-disciplinary application of aviation protocols and plans to borrow from the success of the airline cockpit to develop universal protocols for the cardiovascular OR.

The airline industry has conducted extensive systems analysis of interactions in the cockpit as well as between cockpit and support staff. From sentinel event analysis and behavioral study, the industry has learned to manage cockpit resources for maximum effectiveness and error prevention. According to industry publications, since the implementation of Human Resource Management systems in the 1970’s, commercial airline disasters have become rare.

Peter F. Drucker, noted management consultant, says that large healthcare institutions may be the most complex organizations in human history. At the core of such institutions, the cardiac OR is a hive of high-tech electronic equipment staffed by exacting professionals. These teams must work smoothly together to ensure positive outcomes. There are currently no universal protocols that weave specialized surgical teams into an integrated whole. Cardiac anesthesiologists have an opportunity to “pilot” these teams and weave their collective efforts into precise, consistent results.

Obviously, effective communication in the operating room is critical. The Joint Council on Accreditation of Healthcare Organizations (JCAHO), the standards-setting and accrediting body in health care since 1951, noted that 60% of all sentinel events from 1995-2004 were caused by communication errors. In anesthesia related sentinel events, communication errors increased from 38% of all errors from 1995-2004 to almost 80% in 2005.

Few, if any, physicians have taken advantage of the advances in human systems engineering gained by the airline industry. The FOCUS project will take years from its inception to final guidelines for Human Resource Management (HRM) in the cardiac ORs. The SCA is committed to guiding the creation of universal guidelines to save human lives in the cardiac OR to completion.

The FOCUS project includes the following steps over the next two to three years:

  • Hire a team of consultants to manage and monitor the project.
  • Observe cardiac surgery at approximately 3-5 academic and/or private practice centers to note the human interactions, error patterns, and any potential areas for intervention.
  • Develop potential intervention points where changes in behavior, systems, or other factors could decrease the chance for human error.
  • Implement a strategy to take the findings and build upon them for more SCA research studies, and educational seminars.
  • Undertake a major marketing campaign to educate physicians nationwide and implement the FOCUS OR Guidelines in health care facilities.

Your contribution is critical

This project requires the teamwork of skilled consultants, medical personnel and human engineers. Without your support, we cannot build protocols for universally effective OR teams. Your donation will make a critical difference in the SCA’s ability to follow this project through to fruition.

Visit our FOCUS Blog.

1Kohn L, Corrigan JM, Donaldson MS. To err is human; building a safer health system. Washington, DC: National Academy Press; 1999.

2Caprice K. Christian, MD, MPH and others, “A prospective study of patient safety in the operating room,” SURGERY, February 2006, 159-173.