Introduction to Human Factors in Surgery
As surgeons in training, we became familiar with routine. The 10-minute scrub for our first case of the day, the ritual of draping, and the synchronized actions of surgeons, assistants, and scrub techs. The counting of sponges, needles, and instruments re
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Introduction to Human Factors in Surgery Bruce L. Gewertz
As surgeons in training, we became familiar with routine. The 10-minute scrub for our first case of the day, the ritual of draping, and the synchronized actions of surgeons, assistants, and scrub techs. The counting of sponges, needles, and instruments repeated twice. These rituals developed slowly over many years and were codified by all hospitals and slavishly examined by regulatory agencies. In the back of our minds, we knew they were introduced to lessen infections, improve the speed of operations, and avoid inadvertently leaving foreign objects inside operated patients. But, in truth, they were just part of our daily practice, like brushing our teeth. They were “hard wired” into our behaviors. All that said, we knew that devotion to these practices was less than uniform. We all observed those who decided 10 minutes was just too long to scrub, and besides, they had other things on their mind. Sometimes a second count of the instruments was just too time consuming; after all, we looked into the wound and there was no way anything was left in there. And most of the time, nothing happened. The infection rates were low, hemostats did not appear in postoperative X-rays. And yet, every once in a while and in every hospital, bad things happened. A cluster of infections occurred in implanted heart valves, two patients developed abscesses from retained sponges, and the wrong finger was operated on. These failures – and surely, they were failures of the worst kind – were not due to inherently faulty practices. They were, in the main, due to people not following those practices or guidelines. Possibly their behaviors also reflected larger, more systemic deficiencies including institutional demands that made surgeons rush through procedures, inefficient designs of the operating suites, or lack of training and supervision. But all resulted in people not following established protocols and putting patients at risk.
B. L. Gewertz (*) Cedars-Sinai Medical Center, Los Angeles, CA, USA e-mail: [email protected] © Springer Nature Switzerland AG 2020 T. N. Cohen et al. (eds.), Human Factors in Surgery, https://doi.org/10.1007/978-3-030-53127-0_1
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B. L. Gewertz
The science of human factors is focused on investigating these disconnects and identifying solutions to remedy them. Human factors research began in other high- risk industries such as military operations, industrial sites, and aviation and has only been widely applied to medicine in the last 15 years. The field takes the most expansive view of the environment we work in and asks how that environment helps or hinders the behaviors of the people that work there. As research has evolved, much emphasis has been placed on more precisely quantitating these environmental factors and the attitudes and behaviors that contribute to safe behavior. There are compelling reasons for incorporating more human factors analysis in our practices. For one, the pace of technology development in our fields has been acceler
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