The role of structured observational research in health care

Structured observational research involves monitoring of healthcare domains by experts to collect data on errors, adverse events, near misses, team performance, and organisational culture. This paper describes some of the results of structured observational studies carried out in health care. It evaluates the strengths, weaknesses, and future challenges facing observational researchers by drawing lessons from the human factors and neonatal arterial switch operation (ASO) study in which two human factors specialists observed paediatric cardiac surgical procedures in 16 UK centres. Lessons learned from the ASO study are germane to other research teams embarking on studies that involve observational data collection. Future research needs robust observer training, clear measurable criteria to assess each researcher’s domain knowledge, and observational competence. Measures of inter-rater reliability are needed where two or more observers participate in data collection. While it is important to understand the factors that lead to error and excellence among healthcare teams, it is also necessary to understand the characteristics of a good observer and the key types of error that can occur during structured observational studies like the human factors and ASO project.

[1]  John C. Morey,et al.  Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. , 2002, Health services research.

[2]  Nick Barber,et al.  Ethnographic study of incidence and severity of intravenous drug errors , 2003, BMJ : British Medical Journal.

[3]  David W Bates,et al.  Medication errors observed in 36 health care facilities. , 2002, Archives of internal medicine.

[4]  B Dean,et al.  Validity and reliability of observational methods for studying medication administration errors. , 2001, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[5]  K. Taxis,et al.  An observational study of intravenous medication errors in the United Kingdom and in Germany , 2003, Pharmacy World and Science.

[6]  R. Helmreich,et al.  The importance of human factors in the operating room. , 1994, Anesthesiology.

[7]  Matthew B Weinger,et al.  Assessment of the Intrarater and Interrater Reliability of an Established Clinical Task Analysis Methodology , 2002, Anesthesiology.

[8]  L. Andrews,et al.  An alternative strategy for studying adverse events in medical care , 1997, The Lancet.

[9]  R L Wears.  Beyond error. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[10]  M R de Leval,et al.  The human factor in cardiac surgery: errors and near misses in a high technology medical domain. , 2001, The Annals of thoracic surgery.

[11]  Jean-Blaise Wasserfallen,et al.  Human errors in a multidisciplinary intensive care unit: a 1-year prospective study , 2001, Intensive Care Medicine.

[12]  N C Boreham,et al.  Clinical risk and collective competence in the hospital emergency department in the UK. , 2000, Social science & medicine.

[13]  Y. Donchin,et al.  A look into the nature and causes of human errors in the intensive care unit , 2022 .

[14]  James T. Reason,et al.  Behavioural markers of surgical excellence , 2003 .

[15]  J. Reason,et al.  Human factors and cardiac surgery: a multicenter study. , 2000, The Journal of thoracic and cardiovascular surgery.

[16]  A. O’Connor,et al.  Communication loads on clinical staff in the emergency department , 2002, The Medical journal of Australia.

[17]  R L Helmreich,et al.  Human factors and safety in emergency medicine. , 1994, Resuscitation.

[18]  Emily S. Patterson,et al.  Research Paper: Improving Patient Safety by Identifying Side Effects from Introducing Bar Coding in Medication Administration , 2002, J. Am. Medical Informatics Assoc..

[19]  Colin F. Mackenzie,et al.  SPECIAL SECTION: Comparison of Self-Reporting of Deficiencies in Airway Management with Video Analyses of Actual Performance , 1996, Hum. Factors.

[20]  R. Helmreich,et al.  Safety in the operating theatre--part 1: interpersonal relationships and team performance. , 1995, Current anaesthesia and critical care.

[21]  Webster.  Webster's Dictionary , 1986 .

[22]  Charles Vincent,et al.  Applying human factors methods to clinical risk management in obstetrics , 1997, British journal of obstetrics and gynaecology.

[23]  C MacKenzie,et al.  Information acquisition from audio-video-data sources: an experimental study on remote diagnosis. The LOTAS Group. , 1999, Telemedicine journal : the official journal of the American Telemedicine Association.

[24]  W. Cordell,et al.  Emergency department workplace interruptions: are emergency physicians "interrupt-driven" and "multitasking"? , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[25]  Matthew B. Weinger,et al.  Reengineering Intravenous Drug and Fluid Administration Processes in the Operating Room: Step One: Task Analysis of Existing Processes , 2002, Anesthesiology.

[26]  R. Helmreich.  On error management: lessons from aviation , 2000, BMJ : British Medical Journal.

[27]  David M. Gaba,et al.  Situation Awareness in Anesthesiology , 1995, Hum. Factors.

[28]  M. Brooke,et al.  The Webster’s dictionary , 1999, Neurology.