Is it possible for cardiac surgery teams to completely eliminate medical errors? That's the goal of an ambitious project—called the "Flawless Operative Cardiovascular Unified Systems" (FOCUS) initiative—being undertaken by the Society of Cardiovascular Anesthesiologists (SCA). An introduction and update on the FOCUS initiative appears in a special article in the February 2010 issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS) and the SCA.
"Preventing humans from making mistakes may be nearly impossible, but the SCA FOCUS initiative is predicated on the strong belief that making an error-free medical environment can be achieved," comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia.
FOCUS Initiative Takes Scientific Approach to Learning How Errors Occur
Human error in the course of delivering medical care is a significant source of patient injury, contributing billions of dollars to annual health care costs. "Numerous interventions have been proposed, and some implemented, to reduce risk to patients," says Dr. Shafer. "Remarkably, there is little evidence that any of them actually work."
The SCA—an international society of academic and private practice anesthesiologists who specialize in providing clinical care to patients undergoing heart surgery—is taking action to address this complex problem. The FOCUS initiative is a unique, large-scale research program taking a scientific approach to making "harm-free" cardiac surgery a reality.
The FOCUS Initiative will be carried out by the Johns Hopkins University Quality and Safety Research Group, under the leadership of Dr. Peter Pronovost, Professor of Anesthesiology at the Johns Hopkins University School of Medicine. Dr. Pronovost is internationally recognized for his work in implementing practical solutions to improving patient safety in the critical care environment. Dr. Pronovost has assembled experts from a wide range of disciplines—including organizational sociology, human factors engineering, industrial psychology, and clinical medicine—in a unified effort to identify the hazards associated with cardiac surgery.
Observational Data to Be Analyzed by 'Safety Science' Techniques
Efforts are underway to identify systems-based factors that may contribute to medical errors during cardiac surgery. The FOCUS team is gathering data by direct observation of procedures in a pilot study at five hospitals, which have agreed to a comprehensive analysis of the care provided in their cardiac operating rooms. After identifying potential hazards, the FOCUS team will use rapidly evolving "safety science" methods to determine how to mitigate risks. This will be followed by the most ambitious aspect of the program: the development of an external non-regulatory "peer-to-peer" review process to find out which approaches actually work to reduce patient risks.