54 The frequency and impact of procedural distractions and interruptions in the adult cardiac catheterisation laboratory

Abstract

Purpose To understand factors contributing to disturbances during cardiac procedures, including frequency and nature of distractions, along with assessment of operator ‘work-load’ through NASA Task-load indices. Methods A single centre prospective observational study was conducted on 194 consecutive patients undergoing cardiac procedures in 3 adult cardiac CL’s over a period of 4 weeks. A distraction pro-forma was completed for each case by CL team members (predominantly physiologists), documenting procedural logistics and referring both to the level of risk of the procedure at that time (table 1) and frequency, nature and magnitude of each distraction/interruption (table 2). The primary operator completed a NASA Task-load questionnaire rating parameters to include mental and physical effort, level of frustration, time–urgency, and overall effort and performance on a scale of 1 – 21. Results 264 distractions occurred in 106 procedures (55% of total); 80% were not relevant to the case being undertaken; 13% were due to emergencies occurring in the ‘Hot- Lab’ predominantly to discuss potential ST-elevation myocardial infarction requiring emergency angioplasty. Frequency of distractions per case ranged from 1 to 16, with an average of 2.5; 16% (n=43) of these were documented to occur during high-risk stages (categories 3 or 4) of the procedure. Operator rating of NASA task-load parameters demonstrated higher levels of ‘mental’ and ‘physical’ workload and ‘effort’ when distractions occurred (figure 1). Conclusion In this first description of human factors in the adult cardiac CL we have shown that less than half of all procedures are completed without interruption/distraction. The vast majority of these are unnecessary and without relation to the case or list. We therefore propose the introduction of a ‘sterile cockpit’ environment in the CL, as has been adapted from the aviation industry within surgical operating theatres, to minimise non-emergent interruptions and disturbances, in an attempt to improve operator conditions and overall patient safety. Conflict of Interest Nil