SCA begins new initiative to make 'error-free' cardiac surgery a reality

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.

As described in the recent book Outliers by Malcolm Gladwell, culture has a great deal to do with errors, and flawless execution of clinical care requires fundamental shifts in culture and team management. "The goal of the FOCUS initiative is to substantially decrease the incidence and severity of human error in the cardiac operating room through scientific analysis leading to culture change," write Dr. Bruce Spiess and colleagues in an accompanying editorial.

The SCA Foundation and the Johns Hopkins Group have finished the initial observation/data-gathering phase. Preliminary analyses describe the data as "robust" in terms of areas for intervention and culture change; initial reports will be published this year. The FOCUS Initiative is also garnering input/collaboration with other key stakeholder organizations—including the Association of Operating Room Nurses, the Society of Thoracic Surgeons, and the American Society of Extracorporeal Technology—to extend the study of potential human error throughout the postoperative period.

"FOCUS will be a force for years to come both in gathering scientific data—but more importantly, providing feedback to make operating rooms ever more error-free," Dr. Spiess comments. "Anesthesiology has long led medicine in establishing patient safety. FOCUS is a natural extension of that specialty-wide dedication to making the operative environment as safe as possible."

Dr. Steven N. Konstadt, President of the SCA, adds: "The FOCUS research project is the latest manifestation of the SCA's commitment to patient safety. This groundbreaking project is rapidly gathering momentum and is very likely to soon offer real insight into facilitating intraoperative communication, reducing human error, and improving patient outcomes."

Source: International Anesthesia Research Society