Critical tasks and errors associated with intercostal chest drain insertion

Abstract

Introduction: To describe critical tasks and errors associated with intercostal chest drain insertion, in order to develop enhanced procedural guidelines for task performance and training. Methods: Expert emergency medicine physicians participated in a three-phased study. First, hierarchical task analyses was used to identify tasks, sub-tasks, and the sequence of tasks. Second, systematic human error reduction and prediction approach was used to identify and classify the errors associated with each sub-task culminating in a probability, criticality, and detectability rating for each error. Third, failure modes, effects and criticality analysis technique was used to convert probability and criticality estimates to occurrence and severity scores. Criticality index score, a measure of the propensity for the error to cause harm or procedural failure for each error, was calculated and the top 20 errors most likely to cause harm were ranked. Results: Thirteen tasks and 61 sub-tasks were identified and yielded 86 potential errors. Error classification included errors of action, checking, and selection. The error with the highest criticality score was 'identifying a point of entry lower than the fifth intercostal space'. The top four ranked errors all relate to the identification and correct marking of the location site for the intercostal drain within the safe triangle. Conclusions: Tasks and sub-tasks associated with intercostal chest drain insertion was described and evaluated for criticality. The most critical task was the correct identification of a safe insertion point. Applications include development of procedural guidelines with tasks vulnerable to error highlighted and training interventions that promotes safe task performance. Key messages: What is already known on this topic - intercostal chest drain insertion is associated with significant risks and complications from erroneous placements. Competency and training issues suggest that better guidelines and newer training approaches are needed. What this study adds - the hierarchical task analysis and related methodologies utilized here culminates in a complete list of task steps including the technical and non-technical aspects of the task, identifies the credible errors associated with each task, and highlights the most critical errors in terms of the potential to cause patient harm. How this study might affect research, practice or policy - the findings of this study can be developed into procedural guidelines, checklists for performance assessment, training materials, and organizational policies to support safe task performance.