• Paul Rutherford

PIT STOP


Mr Francis Wells – cardiac surgeon at Papworth Hospital in Cambridge - says that his approach to surgery is greatly influenced by Leonardo da Vinci. He says that the great artist’s anatomical drawing and notations show an insight into the reality of the human heart that outstrips the knowledge of many junior doctors today. In a paper that Wells co-authored for The Journal of Thoracic and Cardiovascular Surgery, he contends that da Vinci’s interest in everything around him generated connections that others wouldn’t see for at least another 200 years. Da Vinci wasn’t just a brilliant anatomist. He was also interested in acoustics, aquanautics, botany, engineering, geology, geography, meteorology... It was his observation of rivers that gave him profound insight into the flow of blood through the human system and the role played by chambers and valves at a time when direct measurement was impossible. (He painted the Mona Lisa and The Last Supper just to pay the bills.) How much we distrust the generalist today (although it’s worth noting that 16th century academics weren’t too keen on da Vinci back then); at a time of increasing specialization, and the ‘discovery’ of sub-niches within niches, when we have a problem we must bring in ‘the expert’ – someone who knows more and more about less and less. “Yes, because the world is so much more complicated now, with so much more technology. Experts who know our field are the only people who can show us the way through.” The cardiac surgery team at Great Ormond Street Hospital (GOSH) in London didn’t think so: In a paper published in Paediatric Anaesthesia, they report on the unacceptable number of technical and information errors that occurred in the post-operative handover from surgery to intensive care. Ventilation, monitoring lines, inotropes and vasodilators all have to be transferred twice; human error was impacting the quality and rate of patient recovery. The obvious place to look for improvement was other hospitals to see how they handled the task. You can almost hear the cry of “Let’s Benchmark!” now. Instead, the team contacted the Ferrari F1 team.

A Formula 1 pit-stop is one of the most tightly-choreographed, efficient models of how a multi-profession team comes together to perform a complex task under huge time pressure. Four tyre changes, driver visibility check and, until the 2010 ban, refuelling.

Watching the Ferrari mechanics at work, the GOSH team identified 11 ‘safety themes’ in which the pit lane outperformed their theatre. From this, they devised a better handover protocol – simple, reliable and easily trainable. The result: technical errors reduced, information omissions closed, and time to intensive care reduced by 90 seconds. Leonardo would be proud.

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