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Pit stop heart surgery

Formula one racing car: Copyright www.iStockphoto.com 000014213027

The Formula 1 car screams to a stop in the pit-lane. Seven seconds later, it has roared away again, back into the race. In those few seconds it has been refuelled and all four wheels changed. Formula 1 pit-stops are the ultimate in high-tech team work. Now the Ferrari pit stop team have helped improve the hospital care of children after open-heart surgery!

Open-heart surgery is obviously a complicated business. It involves a big team of people working with a lot of technology to do a complicated operation. Both during and after the operation the patient is kept alive by computer: lots of computers in fact. A ventilator is breathing for them, other computers are pumping drugs through their veins and yet more are monitoring them so the doctors know how their body is coping.

Pass it on

One of the critical times in open-heart surgery is actually after it is all over. The patient has to be moved from the operating theatre to the intensive care unit where a 'handover' happens. All the machines they were connected to have to be removed, moved with them or swapped for those in the intensive care unit. Not only that, a lot of information has to be passed from the operating team to the care team. The team taking over need to know the important details of what happened and especially any problems, if they are to give the best care possible.

A research team from the University of Oxford and Great Ormond Street Hospital in London wondered if hospital teams could learn anything from the way other critical teams work. This is an important part of computational thinking - the way computer scientists solve problems. Rather than starting from scratch, find a similar problem that has already been solved and adapt its solution for the new situation.

Just as the pit-stop team are under intense time pressure, the operating theatre team are under pressure to be back in the operating theatre for the next operation as soon as possible. In a handover from surgery there is lots of scope for small mistakes to be made that slow things down or cause problems that need to be fixed. In situations like this, it's not just the technology that matters but the way everyone works together around it. The system as a whole needs to be well designed and pit stop teams are clearly in the lead.

Smooth moves

To find out more, the research team watched the Ferrari F1 team practice pit-stops as well as talking to the race director about how they worked. They then talked to operating theatre and intensive care unit teams to see how the ideas might work in a hospital handover. They came up with lots of changes to the way the hospital did the handover.

For example, in a pit-stop there is one person coordinating everything - the person with the 'lollipop' sign that reminds the driver to keep their brakes on. In the hospital handover there was no person with that job. In the new version the anaesthetist was given the overall job for coordinating the team. Once the handover was completed that responsibility was formally passed to the intensive care unit doctor. In Formula 1 each person has only one or two clear tasks to do. In the hospital people's roles were less obvious. So each person was given a clear responsibility: the nurses were made responsible for issues with draining fluids from the patient, anaesthetist for ventilation issues, and so on. In Formula 1 checklists are used to avoid people missing steps. Nothing like that was used in the handover so a checklist was created, to be used by the team taking on the patient.

These and other changes led to what the researchers hoped would be a much improved way of doing handovers. But was it better?

Calm efficiency saves the day

To find out they studied 50 handovers - roughly half before the change was made and half after. That way they had a direct way of seeing the difference. They used a checklist of common problems noting both mistakes made and steps that proved unusually difficult. They also noted how well the teams worked together: whether they were calm and supported each other, planned what they did, whether equipment was available when needed, and so on.

They found that the changes led to clearly better handovers. Fewer errors were made both with the technology and in passing on information. Better still, while the best performance still happened when the teams worked well, the changes meant that teamwork problems became less critical.

Pit-stops and open-heart surgery may be a world apart, with one being about getting every last millisecond of speed and the other about giving as good care as possible. But if you want to improve how well technology and people work together, you need to think about more than just the gadgets. It is worth looking for solutions anywhere: children can be helped to recover from heart surgery even by the high-octane glitz of Formula 1.