Human reliability analysis: a new method to quantify errors in cataract surgery

Purpose: To describe the application of human reliability analysis (HRA) as a tool to quantify errors that occur during small incision cataract surgery. Methods: Sixteen consecutive phacoemulsifications performed by one surgeon were assessed using HRA. Results: Although there were no complications or adverse outcomes associated with any of the operations, 84 errors, which could potentially have caused a complication were noted. The commonest single error was difficulty in 'cracking' the nucleus. Conclusions: HRA attempts to recognise all errors that occur during a procedure rather than just the ones that result in a complication. As such it is a sensitive and prospective method of assessment of surgical performance. It would appear to be of value in the training and assessment of cataract surgery.