Formula One racing, as identified by the Federation Internationale de l’Automobile (FIA), is the top class of sanctioned automotive racing in the world. Eleven teams competed in the 2006 season, which included 18 Grand Prix races. With vehicle speeds well beyond 200 miles-per-hour, engines surpassing 20,000 revolutions per minute, neck-jarring cornering g-forces and ultra-refined handling, the drivers depend on precise specifications to avert disaster. Miss a critical point and face the horrendous consequences.
Similarly, surgeons encounter highly exacting standards in executing the tasks of their profession. Not only do complex procedures themselves require perfect accuracy, but the post-operation period afterward demands flawless technique. Misfile paperwork, engage the wrong equipment or delay a patient transfer and deal with the severe results.
According to a recent Wall Street Journal article, one British hospital has turned to motor sports in an effort to reduce patient complications due to faulty procedure. Led by pediatric intensive care chief Allan Goldman, the Great Ormond Street Hospital in London commissioned Ferrari’s Formula One team to help improve the hospital’s method of transferring patients, or the “handoffs” that occur when a patient is moved from one unit to another or from one shift of staff to the next. A study conducted in 2005 revealed that approximately 70 percent of preventable hospital mistakes occur due to communication errors, and about half of mishaps take place during handoffs.
The connection with car racing came about serendipitously. During a Sunday in 2003, Dr. Goldman and Dr. Martin Elliot, a surgeon, sat down to watch the Formula One race on television after a difficult week. They noticed that the pit stops - the quick periods during which tires are switched, fuel added, aerodynamic body panels adjusted and air vents cleaned – were remarkably similar to patient transfers in the hospital. But whereas pit stops occurred seamlessly in just seconds, hospital handoffs happened slowly and often chaotically.
Intrigued, the two doctors contacted members of McLaren, a manufacturer that fields an F1 car. The team of racers demonstrated the need to eliminate small errors rather than concentrating exclusively on large ones. Previously, a surgeon named Marc de Leval at Great Ormond had postulated in a published paper that minor “human factors,” not major procedural failures, accounted for many complications during and after surgery.
When Dr. de Leval heard the McLaren team’s presentation he contacted Ken Catchpole, a human-factors expert, for further research. Eventually in 2005, Catchpole, Dr. Elliot and Dr. Goldman visited with Nigel Stepney, Ferrari's racing team technical director, in Maranello, Italy. After viewing videotape of Great Ormond’s handoff procedure, Stepney was struck by how “clumsy and informal” the task appeared.
Pit stops often occur in silence, as team members execute their assigned tasks and are clearly aware of leadership designations. But in the Great Ormond Street Hospital, doctors and nurses would carry on multiple conversations without always knowing who was in charge. There was also little foresight at the hospital, as complications would only be addressed after a situation arose. In racing, Ferrari always had contingencies in place should a circumstance require immediate adjustment.
Armed with their newfound knowledge, Dr. Goldman, Dr. Elliot and their colleagues began implementing policy inspired by Ferrari pit stops. A seven-page protocol was formulated outlining patient handoff procedures. From December of 2003 to December 2005, studies of patient transfers were completed to determine the effectiveness of the program. The results were encouraging. Based on 50 instances – 23 before the Ferrari technique and 27 after – technical errors per patient transfer declined 42 percent while information omissions dropped 49 percent.
Some doctors were hesitant to adopt the program, believing the old method to be sufficient. Dr. Goldman also stopped short of placing hospital teammates in pre-determined positions around patients, allowing some flexibility in execution. As implemented, however, the technique was clearly beneficial.
Source: The Wall Street Journal [Registration required] and Formula One
Image: Shell and Ferrari Motorsport
Special thanks: Charlie Aronovici
