Human factors in the development of complications of airway management: Preliminary evaluation of an interview tool

R. Flin (Lead / Corresponding author), E. Fioratou, C. Frerk, C. Trotter, T. M. Cook

    Research output: Contribution to journalArticlepeer-review

    102 Citations (Scopus)

    Abstract

    The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) analysed reports of serious events arising from airway management during anaesthesia, intensive care and the emergency department. We conducted supplementary telephone interviews with 12 anaesthetists who had reported to NAP4, aiming to identify causal factors using a method based on the Human Factors Investigation Tool (HFIT). We identified contributing human factors in all cases (median [range] 4.5 [1-10] per case). The most frequent related to: situation awareness (failures to anticipate, wrong decision) (nine cases); job factors (e.g. task difficulty; staffing, time pressure) (eight cases); and person factors (e.g. tiredness, hunger, stress) (six cases). Protective factors, such as teamwork and communication, were also revealed. The post-report HFIT interview method identified relevant human factors and this approach merits further testing as part of the investigation of anaesthetic incidents.

    Original languageEnglish
    Pages (from-to)817-825
    Number of pages9
    JournalAnaesthesia
    Volume68
    Issue number8
    DOIs
    Publication statusPublished - Aug 2013

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine

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