Totally endoscopic cartilage tympanoplasty: a hierarchical task analysis

BACKGROUND

Totally endoscopic ear surgery is a novel method of conducting otological surgery. Hierarchical task analysis and the systematic human error reduction and prediction approach ('SHERPA') are valuable tools that can effectively deconstruct the technical and non-technical skills required to successfully complete a surgical procedure.

METHODS

Twenty-five endoscopic tragal cartilage tympanoplasties were observed, to identify the tasks and subtasks required for completion of totally endoscopic tragal cartilage tympanoplasty. The systematic human error reduction and prediction approach was used to identify the potential risks and methods, to reduce or remediate these risks.

RESULTS

A hierarchical task analysis was performed, identifying 8 tasks and 50 subtasks for a safe approach to completing totally endoscopic tragal cartilage tympanoplasty. A risk score for each subtask was calculated to produce a systematic human error reduction and prediction approach and to highlight potential errors.

CONCLUSION

This hierarchical task analysis allowed for quick reference to a correct method of endoscopic tympanoplasty. The systematic human error reduction and prediction approach was employed to reduce the risks associated with undergoing endoscopic tympanoplasty, to improve patient safety.

Identification and assessment of nursing task errors in emergency department using SHERPA technique and offering remedial strategies

BACKGROUND

Improving health care quality is a global concern, and providing patients with safe healthcare is a WHO Patient Safety priority. The technological revolution in health services has highlighted the role of human factors in committing such errors, and since the number of medical errors, including nursing errors, increases on a daily basis.

OBJECTIVES

This research aimed to identify the causes of Nursing Task Errors in Emergency Department Using SHERPA Technique and adopt strategies to prevent and reduce them. Participants were 47 nurses (24 women and 23 men), who worked morning, evening and night shifts. The nurses were taught the methodology and talked about the objective of the study; they were then interviewed and observed for six months while working. This way, their tasks and subtasks were demarcated and the Hierarchical Task Analysis (HTA) was performed. SHERPA Error Mode Checklist was used to identify errors and their various types and then risk assessment was conducted.

RESULTS

A total of 45 tasks, 234 subtasks, and 326 errors in regard to nursing activities were identified in the emergency department, with the highest frequency for action errors (61.34%) and the lowest for communication errors (1.84%). Also, there were 7.24 errors per task. The highest and lowest number of errors were at the 'unfavorable' (19.07%) and,'acceptable (safe)' (6.15%) risk levels, respectively. Based on the finding staff training, workload elimination,work process modification and updating guidelines are recommended.

CONCLUSION

The results of present study were also submitted to the University Medical Executive management Committee to make individual, educational and organizational reforms (guidelines and instructions) in order to optimize the situation.