One of the most perilous points when caring for the seriously ill is the handover between surgery and intensive care. As each moment ticks by on the transfer from operating table to ward bed, the risk to the patient increases. It’s an age-old issue, but one that the doctors at Great Ormond Street were determined to improve.
After seeing several of his patients falter during handover, paediatric heart surgeon Professor Marc de Leval was particularly concerned. In an effort to understand why, he recruited a team of ‘human factor specialists’ to assess a number of arterial-switch operations, a procedure designed to fix a congenital heart defect in newborn babies and one which can be particularly fraught with difficulties.
Leval’s study suggested that it was the handover process that was letting the side down. How the hospital could improve its handovers, however, remained largely unresolved until two members of Great Ormond Street’s staff found themselves relaxing in front of a Formula One race on TV after a particularly hard day at work.
“Two of us are F1 fans and we were sitting one Sunday, after a transplant, watching a Grand Prix,” explained Dr Allan Goldman, head of the hospital’s paediatric cardiac intensive care unit. “My colleague Professor Elliot, who is a surgeon, remarked that when you look at a Formula One pit stop, how they all get together is really the epitome of how a team can reconfigure into a functional unit.”
From quick reactions at the start, to optimal acceleration and late braking - efficiency is central to the outcome of a Formula One race. And this need for clear organization and swift reactions is clearest of all during a pit-stop, when crews of 20 highly-trained individuals come together to refuel, re-tyre and fine-tune a car to get it back out on the race track within a matter of seconds.
For Goldman and Elliott the parallels between this and their own challenges were striking. Both involved multiple specialists simultaneously carrying out numerous, complex tasks - tasks that frequently involved complex interfaces, and which all had to be completed quickly and accurately. Upon this realisation the duo quickly set about contacting Formula One teams to ask them to lend their expertise and help the hospital streamline their processes during a patient handover.
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“They’re trying to achieve excellence in winning races, and we’re trying to achieve excellence in patient outcome,” explained Goldman. “Our errors went down by about 30 percent or so. The key thing we found though was that there was a reduction in multiple errors. You notice when you see clips of Formula One that when things go wrong, like a fuel hose gets stuck, the little errors add up and cascade into a major failure.
The awesomeness that is Formula 1 never ceases to amaze me.
