There are many brief, but risky medical/surgical procedures that have great benefit. Such procedures can be life-saving (e.g. chest tube insertion for tension pneumothorax), but can result in major morbidity and mortality. Between 6-36% of all chest tube placements in trauma patients result in complications, morbidity, and mortality. The complications occur because of many factors, including lack of experience of the operator, inadequate supervision, poor preparation, faulty technique, ergonomic and other systems faults. This proposal will conduct a task analysis, examine performance during emergency and elective procedures, and develop a best practice model of chest tube insertion. Trauma Team A (but not Teams B or C) will then be trained in the best practice model and the outcomes (hospital length of stay, complications, costs, etc.) will be compared. The objectives of this proposal are to: 1) demonstrate the value of a video-based procedural analysis for brief, risky, but highly beneficial procedures; 2. develop a research framework for studying effects of team and environmental factors in such procedures; 3) use detailed video, task, and ergonomic analyses to evaluate chest tube insertion with specificity and accuracy; 4) iteratively develop a best practice model of chest tube insertion by review of existing videotapes, and by prospectively collecting videotapes of chest tube insertion in emergency and elective circumstances; 5) test whether training in the use of such a best practice model results in reduced complications and morbidity, increased patient safe6ty, and better long-term outcomes. Using a well established and instrumented audio video acquisition and analysis stem in a major trauma center, a multi-disciplinary team of human factor engineers, anesthesiologists, nurses, and surgeons will collect audio videotapes during chest tube insertion. These videotapes will be rated in focus sessions by participant and non-participant subject matter experts (SME), and undergo interrelated reliability tests. Performance measurements and best training guidelines will be developed from a team cognitive task analysis constructed from commentary during chest tube insertion and SME review. Questionnaires will be used to gather data on dependent and independent variables. Principle component analysis will identify clusters of factors before MANOVA to identify multi-variate interactions. Results of such detailed video, task, and ergonomic analyses have broad application in facilitating reduction of complications, and increased patient safety in other brief risky, but beneficial medical surgical procedures. Principles of how environmental, operator, team, and systems factors impact the outcome of such procedures will be generalizable across many facets of medical procedures to increase patient safety in emergencies or non-ideal circumstances.
