Human reliability analysis of bronchoscope-assisted percutaneous dilatational tracheostomy: implications for simulation-based education

Abstract

Background Teaching and assessing clinical procedures requires a clear delineation of the individual steps required to successfully complete the procedure. For decades, human reliability analysis (HRA) has been used to identify the steps required to complete technical procedures in higher risk industries. However, the use of HRA is uncommon in healthcare. HRA has great potential supporting simulation-based education (SBE) in two ways: (1) to support training through the identification of the steps required to complete a clinical procedure; and (2) to support assessment by providing a framework for evaluating performance of a clinical procedure. The goal of this study was to use HRA to identify the steps (and the risk associated with each of these steps) required to complete a bronchoscope-assisted percutaneous dilatational tracheostomy (BPDT). BPDT is a potentially high-risk minimally invasive procedure used to facilitate tracheostomy placement at the bedside or in the operating theatre. Methods The subgoals, or steps, required to complete the BPDT procedure were identified using hierarchical task analysis. The Systematic Human Error Reduction and Prediction Approach (SHERPA) was then used to identify potential human errors at each subgoal, the level of risk and how these potential errors could be prevented. Results The BPDT procedure was broken down into 395 subgoals, of which 18% were determined to be of high-risk. The most commonly identified remediation strategies for reducing the risk of the procedure included: checklist implementation and audit, statutory and mandatory training modules, simulation training, consultant involvement in all procedures, and fostering a safety-focused hospital culture. Conclusion This study provides an approach for how to systematically identify the steps required to complete a clinical procedure for both training and assessment. An understanding of these steps is the foundation of SBE. HRA can identify ‘a correct way’ for teaching learners how to complete a technical procedure, and support teachers to give systematic and structured feedback on performance.

The application of human reliability analysis to carpal tunnel decompression

“…A limitation of this study, seen throughout HRA methodologies both in healthcare and other industries, is the limited number of SMEs from a single institution available to provide input on constructing the HTA and developing the SHERPA analysis. 6 , 7 This study included input from five SMEs from a single institution. The HTA was derived from a combination of SME input and literature review.…”

“…Human reliability analysis (HRA) is an approach that identifies systematically the impact of human error on a system to reduce adverse events and complications. 7 First developed for use in aviation, HRA has been adopted widely by many industries, including the military and nuclear power generation. 8 , 9 Recent applications of HRA in medicine include adoption by anesthesia, radiology and laparoscopic surgery.…”