Identifying workflow disruptions in the cardiovascular operating room.

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.

Human error analysis of commercial aviation accidents: application of the Human Factors Analysis and Classification system (HFACS).

BACKGROUND: The Human Factors Analysis and Classification System (HFACS) is a general human error framework originally developed and tested within the U.S. military as a tool for investigating and analyzing the human causes of aviation accidents. Based on Reason's (1990) model of latent and active failures, HFACS addresses human error at all levels of the system, including the condition of aircrew and organizational factors. The purpose of the present study was to assess the utility of the HFACS framework as an error analysis and classification tool outside the military. METHODS: The HFACS framework was used to analyze human error data associated with aircrew-related commercial aviation accidents that occurred between January 1990 and December 1996 using database records maintained by the NTSB and the FAA. RESULTS: Investigators were able to reliably accommodate all the human causal factors associated with the commercial aviation accidents examined in this study using the HFACS system. In addition, the classification of data using HFACS highlighted several critical safety issues in need of intervention research. CONCLUSION: These results demonstrate that the HFACS framework can be a viable tool for use within the civil aviation arena. However, additional research is needed to examine its applicability to areas outside the flight deck, such as aircraft maintenance and air traffic control domains.

Human error and crew resource management failures in Naval aviation mishaps: a review of U.S. Naval Safety Center data, 1990-96.

The present study examined the role of human error and crew-resource management (CRM) failures in U.S. Naval aviation mishaps. All tactical jet (TACAIR) and rotary wing Class A flight mishaps between fiscal years 1990-1996 were reviewed. Results indicated that over 75% of both TACAIR and rotary wing mishaps were attributable, at least in part, to some form of human error of which 70% were associated with aircrew human factors. Of these aircrew-related mishaps, approximately 56% involved at least one CRM failure. These percentages are very similar to those observed prior to the implementation of aircrew coordination training (ACT) in the fleet, suggesting that the initial benefits of the program have not persisted and that CRM failures continue to plague Naval aviation. Closer examination of these CRM-related mishaps suggest that the type of flight operations (preflight, routine, emergency) do play a role in the etiology of CRM failures. A larger percentage of CRM failures occurred during non-routine or extremis flight situations when TACAIR mishaps were considered. In contrast, a larger percentage of rotary wing CRM mishaps involved failures that occurred during routine flight operations. These findings illustrate the complex etiology of CRM failures within Naval aviation and support the need for ACT programs tailored to the unique problems faced by specific communities in the fleet.

U.S. naval aviation mishaps, 1977-92: differences between single- and dual-piloted aircraft.

The present study examined U.S. Naval aircraft mishap trends between January 1977 and December 1992 using all Class A, B, and C mishaps. Results of this investigation revealed that mishaps attributable to both human error and mechanical/environmental factors have declined steadily over the past 16 years, although mishaps attributed to human error have declined at a much slower rate. For those mishaps attributed to human error, differences were observed between single- and dual-piloted aircraft when phase-of-flight (takeoff, in-flight, landing) and time-of-day were evaluated. For single-piloted aircraft, in-flight mishaps constituted the highest proportion of mishaps during the day ( > 55%), while landing mishaps constituted the highest proportion of mishaps during the evening and night (43-65%). For dual-piloted aircraft, no consistent variation was evident for phase-of-flight and time-of-day. In-flight (approx. 55%) mishaps constituted the highest proportion of mishaps across all times of day, followed by landing (approx. 35%), and takeoff (approx. 10%) mishaps. These data support focused rather than global investigations of aviation mishaps.

Methamphetamine effects on cognitive processing during extended wakefulness.

We examined the effects of both 5- and 10-mg/7O kg body weight of d-methamphetamine HCl on high event rate vigilance and tracking performance in a 13.5-hr sustained-performance session during one night of sleep loss. At 0116 hours participants were administered either a 5 mg/70 kg oral dose of d-methamphetamine (n=10), 10 mg/70 kg d-methamphetamine (n=10), or a placebo (n=10) using standard double-blind procedures. Performance on all measures degraded markedly during the night in the placebo group. Both the 5- and 10-mg methamphetamines treatment reversed an initial decline in d', and reversed increases in nonresponses (lapses) and tracking error within approximately 3 hr of administration. No evidence that amphetamine treatment increased impulsive responding (fast guesses) was observed. The magnitude of the performance effects of the methamphetamine treatments was similar at 3 hr postadministration. However, the effects of the 5-mg dose were shorter-lived, disappearing by the last testing session (6.5 hr postadministration), whereas effects of the 10-mg dose tended to remain throughout testing. Both amphetamine treatments decreased subjective sleepiness during the night and tended to increase subjective sleep latencies during a post-testing sleep period.