Human Factors Model
So with Human Factors on my mind, and for want of a way to adequately express myself, I was in the supermarket the other day for some BBQ chicken, bread and milk, when.....
There it was.....
The perfect way to illustrate my thinking!
So I bought the AFL Footy ground (pretending it was for the kids)...
And I bought 20 players (pretending they were for the kids)...
And I set to work.
As you can see, I am not much good at model construction, but at last it was a start.
Now....Off to work I go!
Sketching the Idea:
In the beginning there was..... the operating room, the operating table, the anaesthetic machine and the anaesthetic trolley.
Then came the anaesthetist and the anaesthetic nurse, who are in the room by allocation. If you are lucky, there may be a registrar, which is really, really cool.
The anaesthetic nurse and the anaesthetist have checked the equipment at the start of the day, and have established a working rapore, and so are the centrepoint of the expanding team. The anaesthetist or the registrar, by agreement, become the Airway specialist, and the anaesthetic nurse joins that designate and together they become the airway management team,
A & A:
Securing the tube
Positioning the catheter for easy access
The second anaesthetist becomes the line insertion specialist, and the second anaesthetic nurse joins that person as a team, L & L.
Their job, prior to and/or after induction, is to establish monitoring, then put in the drip, the arterial line and the central line if required, and also to manage the drugs:
The Level 1 Nurse (B) sets up the Level 1, then prepares an area to check the blood, collect the used blood bags and record the administered fluids.
This is a one person job, and they will be joined by a second person as needed to check blood and other products prior to administration, as per protocol.
Bring in the Extras!
Other people often join the team if they are available, so the Supervising Anaesthetist (SA) will arrive, and probably another nurse (R) or two.
The strategic role of the SA is to keep an overall view of the evolving scenario.
They allow the others to concentrate on their tasks at hand, eg intubation or arterial line insertion, whilst they manage, for example, the low blood pressure and 'fly the plane'.
Lines of communication become clear.
A communicates with A
L communicates with L
The SA communicates with the anaesthetists A & L
And R communicates with nurses A & L & B, and acts as a runner for each.
The sketched game plan reveals a strategy whereby there is task segregation and demarcation of access and egress, so that there is little crossover of flow and duties.
The anticipation is that this will allow the anaesthetic event to unfold with the maximum of effectiveness and the minimum of confusion.
Of course, life being life, reality will deviate from the preferred.
And so the SA may scrub up and put in the central line whilst L&L struggle with the drip and the art line.
Everyone might get sidetracked by a difficult intubation or the patient arresting.
Or there may only be 1 or 2 nurses available to manage the whole thing.
But the general purpose of the discussion is to work out how to manage best with the optimal number of people working as a high performance team.
Hey....we sort of already do it.
Even better, we might find opportunities within our structure we never realised were there!