title: Locating Errors Through Networked Surveillance: A Multimethod Approach to Peer Assessment, Hazard Identification, and Prioritization of Patient Safety Efforts in Cardiac Surgery.
abstract: OBJECTIVE
  The objectives were to develop a scientifically sound and feasible peer-to-peer assessment model that allows health-care organizations to evaluate patient safety in cardiovascular operating rooms and to establish safety priorities for improvement.
  
  
  METHODS
  The locating errors through networked surveillance study was conducted to identify hazards in cardiac surgical care. A multidisciplinary team, composed of organizational sociology, organizational psychology, applied social psychology, clinical medicine, human factors engineering, and health services researchers, conducted the study. We used a transdisciplinary approach, which integrated the theories, concepts, and methods from each discipline, to develop comprehensive research methods. Multiple data collection was involved: focused literature review of cardiac surgery-related adverse events, retrospective analysis of cardiovascular events from a national database in the United Kingdom, and prospective peer assessment at 5 sites, involving survey assessments, structured interviews, direct observations, and contextual inquiries. A nominal group methodology, where one single group acts to problem solve and make decisions was used to review the data and develop a list of the top priority hazards.
  
  
  RESULTS
  The top 6 priority hazard themes were as follows: safety culture, teamwork and communication, infection prevention, transitions of care, failure to adhere to practices or policies, and operating room layout and equipment.
  
  
  CONCLUSIONS
  We integrated the theories and methods of a diverse group of researchers to identify a broad range of hazards and good clinical practices within the cardiovascular surgical operating room. Our findings were the basis for a plan to prioritize improvements in cardiac surgical care. These study methods allowed for the comprehensive assessment of a high-risk clinical setting that may translate to other clinical settings.
authors.affiliation: From the *Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality; †Johns Hopkins University School of Medicine, ‡School of Nursing, and §Bloomberg School of Public Health, Baltimore, ∥University of Michigan School of Medicine, Ann Arbor; and ¶Massachusetts General Hospital, Harvard University, Boston.
authors.forename: David A
authors.initials: DA
authors.lastname: Thompson
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Ayse
authors.initials: A
authors.lastname: Gurses
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Lubomski
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
authors.forename: John W
authors.initials: JW
authors.lastname: Gosbee
authors.forename: Joyce
authors.initials: J
authors.lastname: Wahr
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Martinez
mesh_terms: D006348:Cardiac Surgical Procedures / Q000592:standards*; D006804:Ergonomics; D005240:Feasibility Studies; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D019300:Medical Errors / Q000517:prevention & control*; D009873:Operating Rooms / Q000592:standards; D015279:Organizational Culture; D061214:Patient Safety; D018024:Peer Review, Health Care / Q000379:methods*; D012189:Retrospective Studies; D017751:Safety Management / Q000379:methods*; D006113:United Kingdom