title: Identifying workflow disruptions in the cardiovascular operating room.
abstract: The objectives of this study were to identify the frequency and nature of flow disruptions in the operating room with respect to three cardiac surgical team members: anaesthetists; circulating nurses; and perfusionists. Data collected from 15 cases and coded using a human factors taxonomy identified 878 disruptions. Significant differences were identified in frequency relative to discipline type. Circulating nurses experienced more coordination disruptions (χ(2) (2, N = 110) = 7.136, p < 0.028) and interruptions (χ(2) (2, N = 427) = 29.743, p = 0.001) than anaesthetists and perfusionists, whereas anaesthetists and perfusionists experienced more layout issues than circulating nurses (χ(2) (2, N = 153) = 48.558, p = 0.001). Time to resolve disruptions also varied among disciplines (λ (12, 878) = 5.186, p = 0.000). Although most investigations take a one-size fits all approach in addressing disruptions to flow, this study demonstrates that targeted interventions must focus on differences with respect to individual role.
authors.affiliation: Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
authors.forename: T N
authors.initials: TN
authors.lastname: Cohen
authors.affiliation: Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Cabrera
authors.affiliation: Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
authors.forename: O D
authors.initials: OD
authors.lastname: Sisk
authors.affiliation: Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Welsh
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Abernathy
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Reeves
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Wiegmann
authors.affiliation: Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Shappell
authors.affiliation: Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Boquet
mesh_terms: D000072077:Anesthetists; D006348:Cardiac Surgical Procedures; D006801:Humans; D009726:Nurses; D009873:Operating Rooms; D010348:Patient Care Team; D024382:Professional Role; D057188:Workflow
keywords: quality measures-patient care; root cause analysis: essential elements