© RDASIA.com Sept 2008 | Words by Juliet Butler
The doctors’ jaws dropped as they watched the pit-stop crew change a Formula 1 car’s tyres, clean its air intakes and fill it with fuel — in seven seconds flat. WHY CAN’T WE DO IT LIKE THIS?
Who would have thought that in spite of the many years doctors spent training to operate/care for patients in ICU, “no one had ever been trained to do a handover. And while long surgery might give them a complex understanding of the patient’s condition, the team to whom they handed over didn’t have that knowledge?”
According to the eye-opening article by Juliet Butler, many deaths have been the result of a lack of coordinated teamwork, “causing a pattern of cascading error—small mistakes that, unnoticed and unrectified, accumulated and sometimes led to catastrophe.“
As research continued it was found that a critical period was the disorderly handover from theater to the ICU. Sometimes the ICU was not informed that a patient was arriving and was not fully prepared. In the crowded, noisy space there could be three or four conversations going on at once; it could take 30 minutes to untangle and plug in all the wires and tubes. With too many things to do at once, some nurses were even scribbling vital handover information on their scrubs.
Then it all changed when ICU doctors Allan Goldman and heart surgeon Professor Martin Elliott tuned in to an F1 race on TV after a gruelling 12-hour emergency heart transplant.
As one car pulled in for a pit stop, both doctors’ jaws dropped as they were struck by the same thought: here was a 20-member crew that could change a car’s tyres, fill it with fuel, clean the air intakes and send it roaring off—in seven seconds flat. There were coordinated, disciplined and rehearsed. Elliott turned to Goldman: “Why can’t we do it like this?”
The doctors took cues from two Formula 1 teams: McLaren and Ferrari. The Chief Medical Officer for McLaren racing team watched a video of a hospital handover, studied the footage then asked, “Why is there so much noise and people colliding with each other, doing things that don’t need doing? Why not space them out and make an organised list of instructions?” When the doctors met with then Ferrari’s technical manager, Nigel Stephney, who watched the video of the handover and he made the following observations:
“I don’t understand,” Stephney said. “Who’s in charge?” … Stephney shoot his head in disbelief. Then he asked more questions: did they brief and debrief? Were there check lists? Did they rehearse without a patient? Each time the doctors said no. Stephey explained: “It’s not about having the best people and just putting them together—it’s about a group of people who can work as a team.” Staff were forgetting basic things — even omitting to switch vital equipment to mains power on reaching the ICU, leaving it on the portable battery system. An hour later the batteries would run out and alarms would sound. Moreover, the medical teams had no briefing for what do do if things did go wrong, being left to use their initiative. Pit-stop crews, by contrast, knew exactly what to do if, for example, a wheel nut rolled away. (Take out the spare in their right hand pocket).