The application of human reliability analysis to three critical care procedures

Background: Procedures carried out in the intensive care unit are prone to human error. Standardisation has been suggested as an approach for reducing errors. This study used human reliability analysis methodologies to examine commonly performed critical care procedures: endotracheal suctioning; ultrasound-guided right internal jugular vein cannulation; and rapid-sequence intubation. Methods: The subgoals, or individual steps, required to complete the three procedures were identified using hierarchical task analysis. The systematic human error reduction and prediction approach was then used to identify potential human errors at each subgoal, the level of risk and how these potential errors could be prevented. Results: Endotracheal suctioning procedure was broken down into 129 subgoals, of which 49 (38.0%) were high-risk. Ultrasound-guided right internal jugular venous cannulation was divided into 224 subgoals, of which 131 (58.4%) were medium-risk, and 20 (8.9%) were identified as high-risk. Rapid sequence intubation was divided into 167 subgoals. A total of 73 (43.7%) of these subgoals were judged to be high-risk. Conclusions: The use of human reliability analysis techniques can support healthcare professionals to gain an in-depth understanding of how particular procedures are carried out in order to reduce the risk of, and improve training in, how to perform these procedures.