Improving safety in high workload environment

Almghairbi, Dalal (2018) Improving safety in high workload environment. PhD thesis, University of Nottingham.

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Background: Recent advances in medical technology, primarily in the anaesthetic and operating rooms, has influenced a change of workload from being just a physical dimensional element to a mental dimensional component also. Evaluations of anaesthesia workload dimensions have become a necessity due to the ever-changing and complexity of such workplace environments, and most essentially, the need for patient safety.

Aim: This project aims to explore techniques for improving the safety of high workload anaesthetic environments.


1) Two systematic reviews were performed: the theoretical framework and supporting data for currently used mental workload assessment tools in the anaesthetic environment; conflict resolution interventions for the improvement of patient safety through understanding and applying/teaching conflict resolution skills.

2) Two observational studies were completed: drug preparation and handling within operating theatres using a novel drug tray; actions and decisions involved in routine and complicated airway management was undertaken.

Results and conclusion:

The most commonly applied and best evidenced measurement tools for workload are self-reported measures. The Borg rating scale was the most commonly used method and showed a consistent association with expected variations in workload. Correlation between self-reported and observed rating was moderate to good.

The overall underlying theme for present educational programs is the enhancement of healthcare professional’s ability to speak up and to positive confidence to challenge their superiors in a positive and effective manner when patient safety is a concern. However, the evidence for training to improve conflict resolution in the clinical environment is sparse.

The Rainbow trays were perceived as likely to reduce drug errors and improve patient safety. Additionally, there was an overall preference for this novel system at all three sites, as they were easy to use and effective. However, there were some limitations to the feasibility of use; related to design and placement. Participants felt some compartments within the Rainbow trays needed to be made larger and there were issues around the best place to place the tray when in use within the operating room.

There were differences in airway practice and preparation between participants. The decisions were primarily made by the lead consultant anaesthetist, with the trainees and ODPs supporting these decisions. A lot of the team communication used code language, but the teams worked well together and this did not appear to cause any problems in the context of routine airway management. Most of the experienced lead consultant anaesthetists rely on their past experience of "work-as-done" during the airway process.

This thesis has shown that it is necessary to continue exploring the approaches to improve safety in anaesthesia environments. In addition, the results from this thesis illustrated that human factor, non-technical, skills are important for ensuring safe, high-quality intraoperative care.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Moppett, Iain
Evley, Rachel
Keywords: Anaesthesia; Patient Safety; Drug Error; Airway Management; Workload; Conflict resolution; Qualitative method
Subjects: W Medicine and related subjects (NLM Classification) > WX Hospitals and other health facilities
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 55031
Depositing User: Almghairbi, Dalal
Date Deposited: 04 Apr 2019 14:36
Last Modified: 06 May 2020 14:47

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