Abstract
Surgical operative performance is currently assessed by audit of morbidity, mortality and, especially in patients with cancer, in terms of long-term outcome. Its chief merit is the identification of problems and sub-optimal results by individual surgeons/centres. There is one aspect of audit that constitutes its intrinsic weakness, the verdict on performance it gives is always retrospective--the problem is identified because of the bad results thrown up by analysis of the data. As a result, there is a distinct possibility that surgeons might exclude patients with potentially curative conditions because of increased operative risk due to co-morbid disease from major surgery because of a fear, conscious or otherwise, of comparative under-performance. There is a methodology in established use by industry that is both prospective and prescriptive in ensuring optimal performance--human reliability assessment (HRA), which can be translated into clinical practice. This paper explains the nature of HRA and reports on its initial use in surgery.
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Selected References
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- Cuschieri A., Weeden S., Fielding J., Bancewicz J., Craven J., Joypaul V., Sydes M., Fayers P. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999 Mar;79(9-10):1522–1530. doi: 10.1038/sj.bjc.6690243. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Drury C. G. Task analysis methods in industry. Appl Ergon. 1983 Mar;14(1):19–28. doi: 10.1016/0003-6870(83)90215-6. [DOI] [PubMed] [Google Scholar]
- Joice P., Hanna G. B., Cuschieri A. Errors enacted during endoscopic surgery--a human reliability analysis. Appl Ergon. 1998 Dec;29(6):409–414. doi: 10.1016/s0003-6870(98)00016-7. [DOI] [PubMed] [Google Scholar]