title: Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study.
abstract: BACKGROUND
  Cardiac surgery is a complex, high-risk procedure with potential vulnerabilities for patient safety. The evidence base describing safety hazards in the cardiovascular operating room is underdeveloped but is essential to guide future safety improvement efforts.
  
  
  OBJECTIVE
  To identify and categorise hazards (anything that has the potential to cause a preventable adverse patient safety event) in the cardiovascular operating room.
  
  
  METHODS
  An interdisciplinary team of researchers used prospective methods, including direct observations, contextual inquiry and photographs to collect hazard data pertaining to the cardiac surgery perioperative period, which started immediately before the patient was transferred to the operating room and ended immediately after patient handoff to the post-anaesthesia/intensive care unit. Data were collected between February and September 2008 in five hospitals. An interdisciplinary approach that included a human factors and systems engineering framework was used to guide the study.
  
  
  RESULTS
  Twenty cardiac surgeries including the corresponding handoff processes from operating room to post-anaesthesia/intensive care unit were observed. A total of 58 categories of hazards related to care providers (eg, practice variations), tasks (eg, high workload), tools and technologies (eg, poor usability), physical environment (eg, cluttered workspace), organisation (eg, hierarchical culture) and processes (eg, non-compliance with guidelines) were identified.
  
  
  CONCLUSIONS
  Hazards in cardiac surgery services are ubiquitous, indicating numerous opportunities to improve safety. Future efforts should focus on creating a stronger culture of safety in the cardiovascular operating room, increasing compliance with evidence-based infection control practices, improving communication and teamwork, and developing a partnership among all stakeholders to improve the design of tools and technologies.
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. agurses1@jhmi.edu
authors.forename: Ayse P
authors.initials: AP
authors.lastname: Gurses
authors.forename: George
authors.initials: G
authors.lastname: Kim
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Martinez
authors.forename: Jill
authors.initials: J
authors.lastname: Marsteller
authors.forename: Laura
authors.initials: L
authors.lastname: Bauer
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Lubomski
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: David
authors.initials: D
authors.lastname: Thompson
mesh_terms: D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000592:standards*; D006804:Ergonomics; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D009873:Operating Rooms; D061214:Patient Safety; D011446:Prospective Studies; D036301:Qualitative Research; D012108:Research Personnel; D018570:Risk Assessment / Q000379:methods*; D017211:Treatment Failure; D014481:United States; D000078329:Workforce