Reducing errors in combined open/endovascular arterial procedures: influence of a structured mental rehearsal before the endovascular phase.
OBJECTIVE
To assess the incidence of errors before and after implementation of a structured mental rehearsal prior to the endovascular phase of combined open/endovascular arterial procedures.


METHODS
Over 6 weeks, 15 combined open/endovascular procedures (7 abdominal aorta and 8 thoracic aorta) lasting 58 hours were evaluated by a trained observer. In a blinded fashion, 2 individuals scrutinized event logs for errors, which were categorized by type, by potential to cause patient harm (danger), and by potential to disrupt the procedure (delay). After 9 procedures, a focus group-devised structured mental rehearsal was implemented prior to the endovascular phase for 6 combined procedures. Error patterns were compared before and after implementation. Data are expressed as median (range).


RESULTS
The error rate during the endovascular phase of the combined procedures was higher than the non-endovascular phase [7.64/hour (1.71-9.6) vs. 3.75/hour (1.71-5.54), respectively; p = 0.05]. Error rates during the endovascular phase were lower after the intervention compared to before [2.5/hour (1.4-6.0) vs. 7.6/hour (1.7-9.6), respectively; p = 0.05]. During the endovascular phase, danger and delay scores were also lower after the intervention [1.2/error (1.0-2.0) and 1.3/error (1.0-2.3), respectively] compared to before [1.75/error (1.4-2.5) and 2.0/error (1.3-2.5), respectively] (p = 0.036 and p = 0.036 for danger and delay, respectively).


CONCLUSIONS
A structured mental rehearsal before critical stages of procedures may reduce the rate and severity of intraoperative error.
Department of Surgery and Cancer, Imperial College London, UK.
Shaneel R
SR
Patel
Manjit S
MS
Gohel
Mohamad
M
Hamady
Mostafa A
MA
Albayati
Celia V
CV
Riga
Nicholas J W
NJ
Cheshire
Colin D
CD
Bicknell
D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057189:Checklist; D002983:Clinical Competence; D003299:Cooperative Behavior; D057510:Endovascular Procedures / Q000009:adverse effects*; D017144:Focus Groups; D006801:Humans; D007092:Imagination; D008131:London; D019300:Medical Errors / Q000517:prevention & control*; D008606:Mental Processes; D009048:Motor Skills; D010348:Patient Care Team; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome