Yes, we're ready to go on bypass.
Perfusionist: Yes, I'm ready for bypass.
Surgeon: Okay, let's go on bypass.
Hospital B
Surgeon: Heparin please.
Anaesthetist: Heparin going in now. *administers heparin*
Perfusionist: Heparin level is therapeutic, I'm ready for bypass.
Surgeon: Okay, let's go on bypass.
Learning: Explicit verbal confirmation of key steps improves safety.
Catchpole K, 2011, in press
Human Factors in Healthcare
l Design of equipment, tasks, jobs, and environments
l Understanding human
STH 2017_Day 3_Track 1_Session 1_Caralis_Preventing Medical Errors Compatibil...Benghie Hyacinthe
The document discusses medical errors and strategies to reduce them. It defines medical errors and notes that they are common, causing thousands of deaths annually in the US. Root cause analysis seeks to identify underlying factors in the healthcare system that contribute to errors in order to implement fixes. Strategies discussed include improving communication, using checklists, increasing staff supervision, and optimizing workload and resources to reduce risk. The goal is to learn from errors by examining the system failures that led to them, rather than blaming individuals.
Fast and Efficient Practice: The Emergency Department Clinician on the Emerge...EmCare
This document summarizes strategies for emergency department clinicians to improve efficiency and patient flow. It discusses organizing the ED to maximize situational awareness and relationships with staff. Clinicians are advised to start shifts strong by seeing patients quickly early on. Improving documentation, such as using templates and dictation, and playing well with others by understanding nursing roles are also covered. The document recommends focusing on value-added activities, avoiding distractions, and improving end-of-shift handoffs to finish shifts efficiently. Self-care strategies like recognizing personal stress levels and boundaries are also presented.
This newsletter from Cardiovascular Interventions provides information on treating cardiovascular diseases. It discusses current treatment strategies for carotid artery disease including aggressive medical therapy with antiplatelets, ACE inhibitors, statins and controlling risk factors. It also discusses revascularization options for carotid stenosis. Additionally, it summarizes the results of a patient satisfaction survey, discusses the relationship between high triglycerides and cardiovascular risk, and provides clinical pearls for managing gastroesophageal reflux disease. The newsletter wishes readers a happy holiday and encourages staying on top of cardiovascular health during this time.
NUEVAS Y VIEJAS FORMAS DE VIOLENCIA Revi 43 observatorio social_14Francisco Chavez
Este documento resume la evolución de diferentes formas de violencia en Argentina en las últimas décadas. Muestra que las tasas de homicidios fueron más altas en la década de 1970 que después del retorno a la democracia en 1983, aunque aumentaron en los años 1990. Los delitos contra la propiedad y las personas aumentaron constantemente desde 1980, pero la percepción social se centró más en el crecimiento de los años 1990 sobre tasas ya altas. La violencia tomó diferentes formas y tuvo distintas trayectorias históricas, pero en general aumentó a lo
Funding your business using a crowd is not a novel idea anymore. However building "tribe" around your business, venture, goal can be even more an effective strategy. Here is some of the "whys" and "hows"
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
STH 2017_Day 3_Track 1_Session 1_Caralis_Preventing Medical Errors Compatibil...Benghie Hyacinthe
The document discusses medical errors and strategies to reduce them. It defines medical errors and notes that they are common, causing thousands of deaths annually in the US. Root cause analysis seeks to identify underlying factors in the healthcare system that contribute to errors in order to implement fixes. Strategies discussed include improving communication, using checklists, increasing staff supervision, and optimizing workload and resources to reduce risk. The goal is to learn from errors by examining the system failures that led to them, rather than blaming individuals.
Fast and Efficient Practice: The Emergency Department Clinician on the Emerge...EmCare
This document summarizes strategies for emergency department clinicians to improve efficiency and patient flow. It discusses organizing the ED to maximize situational awareness and relationships with staff. Clinicians are advised to start shifts strong by seeing patients quickly early on. Improving documentation, such as using templates and dictation, and playing well with others by understanding nursing roles are also covered. The document recommends focusing on value-added activities, avoiding distractions, and improving end-of-shift handoffs to finish shifts efficiently. Self-care strategies like recognizing personal stress levels and boundaries are also presented.
This newsletter from Cardiovascular Interventions provides information on treating cardiovascular diseases. It discusses current treatment strategies for carotid artery disease including aggressive medical therapy with antiplatelets, ACE inhibitors, statins and controlling risk factors. It also discusses revascularization options for carotid stenosis. Additionally, it summarizes the results of a patient satisfaction survey, discusses the relationship between high triglycerides and cardiovascular risk, and provides clinical pearls for managing gastroesophageal reflux disease. The newsletter wishes readers a happy holiday and encourages staying on top of cardiovascular health during this time.
NUEVAS Y VIEJAS FORMAS DE VIOLENCIA Revi 43 observatorio social_14Francisco Chavez
Este documento resume la evolución de diferentes formas de violencia en Argentina en las últimas décadas. Muestra que las tasas de homicidios fueron más altas en la década de 1970 que después del retorno a la democracia en 1983, aunque aumentaron en los años 1990. Los delitos contra la propiedad y las personas aumentaron constantemente desde 1980, pero la percepción social se centró más en el crecimiento de los años 1990 sobre tasas ya altas. La violencia tomó diferentes formas y tuvo distintas trayectorias históricas, pero en general aumentó a lo
Funding your business using a crowd is not a novel idea anymore. However building "tribe" around your business, venture, goal can be even more an effective strategy. Here is some of the "whys" and "hows"
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document discusses the pros and cons of pursuing success through work. It acknowledges that while leaving a 9-5 job for entrepreneurship can lead to financial gains like traveling for work, it can also negatively impact one's health due to stress. However, the author ultimately believes that stepping out of one's comfort zone and pursuing ambitions, rather than staying complacent, is worth it despite the challenges. The key is to stay focused on goals and not allow distractions to undermine hard work and progress.
TECNIO El mercat tecnològic de les empreses catalanes (Álvaro Tapia, ACC10)3D Girona Tic Media
Presentació "TECNIO El mercat tecnològic de les empreses catalanes" a càrrec d'Álvaro Tapia d'ACC1Ó (agència de la Generalitat de Catalunya).
26 d'abril del 2011
Auditori Narcís Monturiol
Jornada IIiA+CDTI+ACC10
Taller oportunitats per projectes de cooperació entre universitat i empreses
El Centro de Animación Juvenil (CAJ) es una organización sin fines de lucro registrada ante el Ministerio de Educación de Venezuela, dedicada al desarrollo socio-comunitario a través de proyectos de educación, organización social, capacitación y formación extra-escolar. El CAJ implementa diversos proyectos en municipios del estado de Trujillo, enfocados en temas como liderazgo comunitario, acceso a las TIC, participación ciudadana, derechos humanos, emprendimiento juvenil y promoción de la niñez y adolescencia
This document provides guidance on safe driving practices for employees. It discusses the importance of seatbelt usage, not using mobile phones while driving, avoiding speeding and drunk driving. Defensive driving techniques are covered such as looking for hazards, maintaining proper distance from other vehicles, and being prepared for emergencies. The document emphasizes taking regular breaks to avoid fatigue when driving long distances.
NetOp School es una herramienta educativa que permite a los profesores controlar remotamente las computadoras de los estudiantes, monitorear su trabajo, distribuir archivos y comunicarse con ellos. Cuenta con módulos separados para profesores y estudiantes. El módulo del profesor ofrece funciones como control remoto, chat, ejecución de programas y exámenes en las computadoras de los estudiantes.
Dick Evers, * designer * feng shui expert * artist *Dick Evers
Dick Evers will search for happiness and balance with you. He does this by applying the Chinese lifestyle Feng Shui. The combination of designer, Feng Shui expert and visionary makes him unique. He also procedures designs according to the rules of Feng Shui that could help your business.
El documento habla sobre la ética en ingeniería de software. Explica que la ética informática analiza problemas éticos creados o agravados por la tecnología de la información. También presenta los principios que deberían guiar a los ingenieros de software, como poner el interés público por encima de otros intereses, asegurar la calidad y seguridad de los productos, y tratar la información de manera privada y responsable.
Our company provides a Bluetooth proximity marketing system that delivers customized text messages to customers inside retail stores. The system identifies Bluetooth devices that come within range and sends targeted marketing messages. We aim to provide endless marketing opportunities for retailers through proprietary wireless technologies, as stated in our mission statement. Currently, our primary target market is upper-end department stores, and our target consumer is individuals aged 25 to 50 with higher incomes and Bluetooth-enabled mobile phones.
The document summarizes the Automotive Seating Reloaded 2014 conference. Over 80 attendees from over 50 companies in automotive seating, interior technologies, seats testing, and lightweight applications gathered to discuss challenges and trends. Presentations were given on topics like innovative materials, ergonomics, and seat development processes. The 2014 conference will be held September 22-23 in Berlin with more sessions, speakers from Europe, Asia and the US, and networking events.
This document appears to be a magazine about the Women in Sales Awards event held in December 2014. It includes interviews with award finalists and speakers from the event. The main topics covered include a profile of Aude Rocourt, the Regional Director for Europe at Bacardi, who discusses her career path and advice for women in sales. It also previews the keynote speakers and lists the award finalists and categories. The magazine serves to recap the recent awards event and honor high-achieving women in sales.
El documento describe la naturaleza de la alianza entre Dios y su pueblo según la Biblia. Explica que la alianza implica un compromiso solemne en el que Dios toma la iniciativa de establecer una relación con la humanidad. Se mencionan las alianzas específicas con Noé, Abraham y Moisés, y cómo la alianza del Sinaí profundizó la religión de los padres. También analiza cómo los escritores deuteronomistas transformaron esquemas políticos antiguos para describir la teología de la
Archivo preparado para el curso deL CPR 'Hablando en Griego' de Murcia y para la lectura de textos clásicos del evento 'Yo conozco mi herencia', organizado por la SEEC y AMUPROLAG (Murcia). Actividad posible para San Valentín o trabajar textos de temática amorosa en clase.
El currículum vitae presenta los datos personales y la experiencia laboral de Claudia Contreras. Detalla su educación formal en negocios internacionales y asistencia gerencial. Describe tres puestos laborales previos en los que se desempeñó como asistente de gerencia, involucrada en importaciones, exportaciones, logística, compras, ventas, facturación e inventarios. También enumera habilidades blandas como liderazgo, toma de decisiones, relaciones humanas y solución de problemas. Proporciona referencias laborales de tres emple
Parameters that are easy and inexpensive to measure and which will not disturb the training process should be preferred in the diagnosis of overtraining.
Unfortunately, a valid parameter that can help coaches and athletes to control training is difficult to find. Moreover, an individual response is very different; therefore athletes should be monitored continuously and analyzed individually. Much of this can be done by athletes themselves during everyday training.
Self-assessment should include:
* Measurement of heart rate during rest
* Subjective assessment of the individual state
* Subjective assessment of workout intensity
1) The ICU at Reinier de Graaf Hospital in Delft works to ensure patient safety through protocols, guidelines, and an intensivist-led closed format.
2) To further increase safety outside the ICU, the hospital introduced a Medical Emergency Team (MET) in 2004 composed of ICU professionals who provide rapid response to patients experiencing medical emergencies.
3) Evidence on the impact of METs is inconclusive but most studies show benefits to patient outcomes and mortality reduction. The hospital believes early detection and treatment of deteriorating patients can prevent serious adverse events.
Risk Management and Patient Safety Evolution and Progress. Charles Vincent. Match Safety critical component of quality (Madrid, Ministry of Health and Consumer Affairs, 2005)
This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
This document discusses the pros and cons of pursuing success through work. It acknowledges that while leaving a 9-5 job for entrepreneurship can lead to financial gains like traveling for work, it can also negatively impact one's health due to stress. However, the author ultimately believes that stepping out of one's comfort zone and pursuing ambitions, rather than staying complacent, is worth it despite the challenges. The key is to stay focused on goals and not allow distractions to undermine hard work and progress.
TECNIO El mercat tecnològic de les empreses catalanes (Álvaro Tapia, ACC10)3D Girona Tic Media
Presentació "TECNIO El mercat tecnològic de les empreses catalanes" a càrrec d'Álvaro Tapia d'ACC1Ó (agència de la Generalitat de Catalunya).
26 d'abril del 2011
Auditori Narcís Monturiol
Jornada IIiA+CDTI+ACC10
Taller oportunitats per projectes de cooperació entre universitat i empreses
El Centro de Animación Juvenil (CAJ) es una organización sin fines de lucro registrada ante el Ministerio de Educación de Venezuela, dedicada al desarrollo socio-comunitario a través de proyectos de educación, organización social, capacitación y formación extra-escolar. El CAJ implementa diversos proyectos en municipios del estado de Trujillo, enfocados en temas como liderazgo comunitario, acceso a las TIC, participación ciudadana, derechos humanos, emprendimiento juvenil y promoción de la niñez y adolescencia
This document provides guidance on safe driving practices for employees. It discusses the importance of seatbelt usage, not using mobile phones while driving, avoiding speeding and drunk driving. Defensive driving techniques are covered such as looking for hazards, maintaining proper distance from other vehicles, and being prepared for emergencies. The document emphasizes taking regular breaks to avoid fatigue when driving long distances.
NetOp School es una herramienta educativa que permite a los profesores controlar remotamente las computadoras de los estudiantes, monitorear su trabajo, distribuir archivos y comunicarse con ellos. Cuenta con módulos separados para profesores y estudiantes. El módulo del profesor ofrece funciones como control remoto, chat, ejecución de programas y exámenes en las computadoras de los estudiantes.
Dick Evers, * designer * feng shui expert * artist *Dick Evers
Dick Evers will search for happiness and balance with you. He does this by applying the Chinese lifestyle Feng Shui. The combination of designer, Feng Shui expert and visionary makes him unique. He also procedures designs according to the rules of Feng Shui that could help your business.
El documento habla sobre la ética en ingeniería de software. Explica que la ética informática analiza problemas éticos creados o agravados por la tecnología de la información. También presenta los principios que deberían guiar a los ingenieros de software, como poner el interés público por encima de otros intereses, asegurar la calidad y seguridad de los productos, y tratar la información de manera privada y responsable.
Our company provides a Bluetooth proximity marketing system that delivers customized text messages to customers inside retail stores. The system identifies Bluetooth devices that come within range and sends targeted marketing messages. We aim to provide endless marketing opportunities for retailers through proprietary wireless technologies, as stated in our mission statement. Currently, our primary target market is upper-end department stores, and our target consumer is individuals aged 25 to 50 with higher incomes and Bluetooth-enabled mobile phones.
The document summarizes the Automotive Seating Reloaded 2014 conference. Over 80 attendees from over 50 companies in automotive seating, interior technologies, seats testing, and lightweight applications gathered to discuss challenges and trends. Presentations were given on topics like innovative materials, ergonomics, and seat development processes. The 2014 conference will be held September 22-23 in Berlin with more sessions, speakers from Europe, Asia and the US, and networking events.
This document appears to be a magazine about the Women in Sales Awards event held in December 2014. It includes interviews with award finalists and speakers from the event. The main topics covered include a profile of Aude Rocourt, the Regional Director for Europe at Bacardi, who discusses her career path and advice for women in sales. It also previews the keynote speakers and lists the award finalists and categories. The magazine serves to recap the recent awards event and honor high-achieving women in sales.
El documento describe la naturaleza de la alianza entre Dios y su pueblo según la Biblia. Explica que la alianza implica un compromiso solemne en el que Dios toma la iniciativa de establecer una relación con la humanidad. Se mencionan las alianzas específicas con Noé, Abraham y Moisés, y cómo la alianza del Sinaí profundizó la religión de los padres. También analiza cómo los escritores deuteronomistas transformaron esquemas políticos antiguos para describir la teología de la
Archivo preparado para el curso deL CPR 'Hablando en Griego' de Murcia y para la lectura de textos clásicos del evento 'Yo conozco mi herencia', organizado por la SEEC y AMUPROLAG (Murcia). Actividad posible para San Valentín o trabajar textos de temática amorosa en clase.
El currículum vitae presenta los datos personales y la experiencia laboral de Claudia Contreras. Detalla su educación formal en negocios internacionales y asistencia gerencial. Describe tres puestos laborales previos en los que se desempeñó como asistente de gerencia, involucrada en importaciones, exportaciones, logística, compras, ventas, facturación e inventarios. También enumera habilidades blandas como liderazgo, toma de decisiones, relaciones humanas y solución de problemas. Proporciona referencias laborales de tres emple
Parameters that are easy and inexpensive to measure and which will not disturb the training process should be preferred in the diagnosis of overtraining.
Unfortunately, a valid parameter that can help coaches and athletes to control training is difficult to find. Moreover, an individual response is very different; therefore athletes should be monitored continuously and analyzed individually. Much of this can be done by athletes themselves during everyday training.
Self-assessment should include:
* Measurement of heart rate during rest
* Subjective assessment of the individual state
* Subjective assessment of workout intensity
1) The ICU at Reinier de Graaf Hospital in Delft works to ensure patient safety through protocols, guidelines, and an intensivist-led closed format.
2) To further increase safety outside the ICU, the hospital introduced a Medical Emergency Team (MET) in 2004 composed of ICU professionals who provide rapid response to patients experiencing medical emergencies.
3) Evidence on the impact of METs is inconclusive but most studies show benefits to patient outcomes and mortality reduction. The hospital believes early detection and treatment of deteriorating patients can prevent serious adverse events.
Risk Management and Patient Safety Evolution and Progress. Charles Vincent. Match Safety critical component of quality (Madrid, Ministry of Health and Consumer Affairs, 2005)
This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
This document discusses surgical safety and errors. It notes that 234 million operations are performed globally each year, with 1 million deaths and 7 million disabling complications, over 50% of which are preventable. Common errors include wrong site surgery, wrong patient surgery, and retained surgical instruments. Causes of errors include lack of protocols, training, supervision, communication breakdowns, and operating outside of one's expertise. Checklists modeled after aviation safety checklists have been shown to reduce complications and deaths when used in surgery. A WHO surgical safety checklist was tested in 8 hospitals globally and significantly reduced death rates and complication rates. Universal adoption of checklists and a culture of safety are seen as keys to reducing preventable surgical errors.
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Abandoning difficult airway algorithms to improve patient safety | Richard Le...scanFOAM
The document discusses abandoning difficult airway algorithms and improving patient safety. Some key points:
1) Predicting difficult intubation is difficult and algorithms often fail to accurately predict difficulty. Most predicted difficult cases turn out to be easy.
2) Video laryngoscopy and new airway devices have reduced risks that were previously associated with direct laryngoscopy. Physiologically difficult airways in critically ill patients remain high risk.
3) First pass success is important for reducing risks. Checklists, checklists, checklists along with optimizing oxygenation, positioning and teamwork can help achieve this. Understanding priorities is more important than memorizing algorithms.
4) Adverse events often result from hypo
This document discusses hybrid operating theaters/environments for treating hemorrhage in trauma patients. It provides an overview of endovascular techniques like transcatheter arterial embolization and balloon occlusion that can be used to treat hemorrhage. Trauma applications like treatment of spleen, liver, kidney and pelvic fractures are mentioned. The role of trauma surgeons working with interventional radiologists is discussed. The document also describes the process of developing a hybrid operating room called RAPTOR at a hospital in Canada, including securing funding, designing the space, and implementing protocols for its use. An analysis found it benefited around 6% of severely injured patients with persistent hemorrhage.
Trauma Management PPT for MBBS Students by Dr Anil Kumar,AIIMS-PatnaAnil Kumar
This document discusses trauma management and the burden of trauma in India. It begins with definitions of key terms like trauma, emergency, and triage. It then summarizes trauma statistics from 2005 and 2011 reports, showing over 4 million hospitalizations and 140,000 deaths annually. The document recommends establishing standardized pre-hospital and hospital protocols based on ATLS guidelines to improve outcomes. Key components of trauma management covered include scene safety, triage, primary and secondary surveys, hemorrhage control, spinal immobilization, and hypothermia prevention.
2012.02.18 Reducing Human Error in Healthcare - Getting Doctors to Swallow th...NUI Galway
Dr Paul O'Connor, Whitaker Institute, NUI Galway presented this seminar "Reducing Human Error in Healthcare - Getting Doctors to Swallow the Blue Pill" as part of the NUI Galway Research Office Lunchtime Seminar Series on 18th January 2012.
This document is a curriculum vitae for a radiographer. It includes personal details like date of birth and nationality. It outlines the applicant's educational background including a diploma in general radiology. Work experience is described at several hospitals over 12 years using various radiology equipment like MRI, CT scans, x-rays, and fluoroscopy. Training courses are listed covering areas like life support, imaging management, computer skills, and English. Duties and responsibilities are provided for areas like CT scanning, MRI, radiation safety, communication, and policy adherence. Languages known and interests are also included.
The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
This document describes a multi-disciplinary project called Designing Out Medical Error (DOME) that aimed to improve patient safety by applying human factors and design principles. The project mapped out processes in surgical ward bedspaces and identified nearly 200 potential failure modes. Solutions addressed issues like equipment design, reminders, monitoring, feedback and standardization. Some solutions, like the CareCentre workstation, were developed into prototypes and tested clinically. The project demonstrated the value of a multi-disciplinary approach and applying human factors principles throughout the design cycle to develop safer healthcare products.
This document discusses surgical safety and errors. It notes that 234 million operations are performed globally each year, with 1 million deaths and 7 million disabling complications, over 50% of which are preventable. Common errors include wrong site, patient, procedure and retained instruments. Causes include lack of protocols, training, supervision, staffing issues and communication breakdowns. Aviation safety practices are presented as a model, with mandatory reporting and a non-punitive culture. The WHO surgical safety checklist is summarized, which was tested in 8 countries and significantly reduced complications and death rates. Universal adoption of checklists and a culture of safety are recommended to improve patient outcomes during surgery.
Detecting Distress in Gynecologic Cancer Patients Worksheet.docxstudywriters
1) A study assessed distress levels in 62 gynecologic cancer patients using the Distress Thermometer and Problem List. 66% of patients scored 4 or higher on the Distress Thermometer, indicating follow up was needed. The top reported problems were nervousness, worry, fears, fatigue, and sleep problems.
2) Staff perceptions of using distress screening tools were also examined through interviews. While screening helped identify patient needs, staff noted high levels of distress required referral to appropriate services.
3) Both quantitative and qualitative data provided insight into the prevalence and types of distress experienced by gynecologic cancer patients, as well as challenges in implementing distress screening in a clinical setting.
Debemos cambiar el paradigma! Para la reanimación del paciente politraumatizado en shock hemorrágico, debemos ser tremendamente cuidadosos y conservadores con el aporte de cristaloides o coloides!
Shock hemorrágico en el paciente politraumatizado, no debe tratarse con fisiológico, Ringer o gelatinas! Mientras más de estos productos reciban, peor pronóstico tiene nuestro paciente.
En este contexto, no debe administrarse nada que no aporte a transportar oxigeno o que colabore con la coagulación!
No más reanimación tipo ATLS, donde se recomendaba 2lt de suero fisiológico y solicitar exámenes para evaluar coagulación y ver necesidad de productos sanguíneos... NO MÁS!!!
Conceptos Claves:
- politraumatizado + shock = hemorrágico (abdomen, tórax, extremidades)
- control anatómico del sangrado es vital!
- no reanimar contra presión arterial, reanimar contra perfusión
- si necesita volumen; aportar fluidos que aporten a la coagulación o a transportar oxígeno
- recuerden calcio y ácido tranexámico
- hosp pequeño, o 1rio o 2ndario: esfuerzos en traslado
- hospital cuidado definitivo: protocolo transfusión masiva, hipotensión permisiva, cirugía control de daño, UCI
In a tertiary care institute of northern India, the emergency department receives an average of 6–7 patients with poly trauma every day. Of these patients, some come directly and many are referred from other hospitals from the region. Various problems are faced in the management of patients with poly trauma. This presentation aimed to elicit various complaints, suggestions and possible solutions in the management of patients with poly trauma.
1) Trauma is a leading cause of death and disability, costing over $400 billion annually in the US.
2) Trauma care involves several phases from pre-hospital care through rehabilitation. Advanced Trauma Life Support (ATLS) provides guidelines for a systematic approach.
3) ATLS emphasizes assessing and stabilizing the airway, breathing, and circulation during the primary survey to identify life-threatening injuries. Additional diagnostics and surgery may then be required.
This document discusses isolated head injuries in pediatric trauma patients and the association with shock and hypotension. The key points are:
1) A study found that among pediatric patients with isolated head injuries, rates of hypotension were highest in those aged 0-4 years, with 1/3 of hypotension cases associated with isolated head injuries in that age group.
2) Several potential causes for this association between isolated head injuries and hypotension in young pediatric patients were hypothesized, including neurogenic or autonomic responses.
3) Due to the risks of cerebral edema from large fluid volumes, providers may need to adjust treatment to include early vasopressors or anticholinergic drugs to support blood pressure in these
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJO.docxjessiehampson
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJON.ONS.ORG
A
Detecting Distress
Introducing routine screening in a gynecologic cancer setting
Moira O’Connor, BA(Hons), MSc, PhD, Pauline B. Tanner, RN, RM, CertOnc, SBCN, Lisa Miller, MBBS, DCH, FRACGP, FAChPm, FRANZCP,
Kaaren J. Watts, BA(Hons), PhD, and Toni Musiello, BA(Hons), MA, PhD
ALONGSIDE PHYSICAL SYMPTOMS AND SIDE EFFECTS of treatment, cancer results
in psychological, social, and practical challenges, which can contribute to
patient distress (Carlson, Waller, Groff, Giese-Davis, & Bultz, 2013). The
International Psycho-Oncology Society highlights distress as a critical factor
affecting patients’ well-being and recommends that distress be named the
sixth vital sign in oncology (Holland, Watson, & Dunn, 2011). The report-
ed prevalence rates of psychological distress in patients with cancer range
from 35%–49% (Carlson, Groff, Maciejewski, & Bultz, 2010). However, the
actual rates of distress are thought to be much higher because of underdetec-
tion. Clinician assessments have been shown to be inferior to gold-standard
methods, such as validated screening tools and clinical interviews (Werner,
Stenner, & Schüz, 2012), and distress is often missed by clinicians (Mitchell,
Vahabzadeh, & Magruder, 2011).
Distress encompasses a range of issues, including psychological, spiritual,
and existential distress, as well as juggling roles and having financial concerns
and practical problems, such as needing help with accommodation or travel.
Distress is associated with poorer physical and psychological quality of life
(Carlson et al., 2010). Detecting distress in patients with cancer can result in
early intervention, which helps avoid patients struggling with unmet or com-
plex needs (Faller et al., 2013). Identifying distress early could also reduce the
financial burden on health services (Han et al., 2015). Healthcare profession-
als (HCPs) must recognize distress so it can be adequately managed (Werner
et al., 2012); to do this, HCPs need to screen all patients systematically.
Several organizations and professional bodies state in their standards
for quality cancer care that psychosocial support should include routine
screening for distress, followed by appropriate referrals targeted to the needs
identified by patients (Holland et al., 2011; Werner et al., 2012). Despite this,
uptake of routine distress screening in clinical oncology settings has been
suboptimal (Mitchell, Lord, Slattery, Grainger, & Symonds, 2012). Many
barriers exist to the successful implementation of routine distress screen-
ing in clinical settings, including a lack of training, clinicians’ perception of
limited skills and confidence in identifying distress, and inadequate referral
resources (Absolom et al., 2011). A shortage of private space has also been
identified (Ristevski et al., 2013). Many HCPs believe that addressing distress
will take too much time. However, appropri ...
Similar to Barach.Human factors HMA talk Sept 4 (20)
Pediatric heart failure can be life-threatening and lead to frequent readmissions. The article discusses the complex factors that contribute to high readmission rates for children with heart failure, including lack of care coordination and continuity. It recommends 10 strategies to improve communication during care transitions and reduce readmissions, such as creating common metrics to track outcomes, recognizing this as a complex adaptive challenge, and engaging clinicians in leadership and redesigning care processes. The goal is to improve outcomes and reduce costs through more coordinated, patient-centered care for this vulnerable population.
This document summarizes a study that assessed current practices in teaching life support competencies in healthcare. The study conducted surveys to: 1) Identify life support courses provided in UK hospitals and required by professional bodies, 2) Describe curriculum content and teaching methods of popular in-hospital courses, 3) Examine fidelity of implementation of courses in England. The study found that most NHS hospitals provide adult life support courses, with the Resuscitation Council UK Advanced Life Support course most common. Many hospitals also provide in-house courses. Recognition and management of pre-arrest deterioration are now widely taught. While life support training is provided in all medical schools, approaches vary and pre-arrest management courses are less common. Only a
This document provides a summary of a human factors analysis conducted of the Pediatric Blood & Marrow Transplantation Unit (PBMTU) at Duke University Hospital. The analysis was conducted over several months in late 2006 and early 2007 by a multi-disciplinary team from Aptima, Inc. The team conducted over 50 interviews and observations to identify stress points and potential failures within the PBMTU system. The analysis utilized several human factors techniques including interviews, observations, modeling, and assessment of the clinical microsystem framework. The report details the assessments and provides recommendations in each area of the framework to improve safety, quality of care, staff retention and the unit's ability to serve more patients.
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The document summarizes a study conducted by the Florida Patient Safety Network on establishing a Patient Safety Authority in Florida. Key points:
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- The Authority would be responsible for activities and functions to improve patient safety and quality of care in health facilities and among practitioners.
- The study examined options for the Authority to directly perform safety functions, or contract with or partner with university patient safety centers.
- The Network coordinated its efforts with various stakeholders and academic medical centers across the state to conduct a comprehensive review and provide recommendations.
The Telluride Interdisciplinary Roundtable met in 2005 and 2006 to design a comprehensive patient safety curriculum for medical students. The group developed 11 specific curricular elements and identified challenges to implementation. A patient safety curriculum was successfully developed over two years. Future meetings focused on evaluating pilots of the curriculum in medical schools and developing new ideas. Continued collaboration between professions will help create a standardized longitudinal patient safety curriculum.
- Management interventions can be divided into targeted service interventions with narrow effects and generic service interventions that have diffuse effects like policy interventions.
- For targeted service interventions, measuring changes in clinical processes is often more cost-effective than measuring patient outcomes in evaluations.
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- Multiple clinical processes are consolidated into a small number of patient outcomes, which are the default primary endpoints for policy and generic service intervention evaluations.
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More from Wayne State University School of Medicine (16)
1. Patient Safety: A Human
Factors Approach
Sept 4, 2015
Paul Barach, BSc, MD, MPH, Maj ( ret.)
Clinical Professor
Wayne State University School of Medicine
4. 4
No
system
beyond
this
point
10-2 10-3 10-4 10-5 10-6
Civil Aviation
Nuclear Industry
Railways (France)
Chartered Flight
Road Safety
Chemical Industry (total)
Fatal
risk
ED/ Medical risk
(total)
Anesthesiology
ASA1
Pedi Cardiac Surgery
Patient ASA 3-5
Fatal Iatrogenic
adverse events
Very
unsafe
Ultra
safe
Average
rate
per
exposure
of
catastrophes
and
associated
deaths
in
various
industries
and
human
acAviAes
Unsafe
Safe
Hymalaya
mountaineering
Microlight spreading
activity
NICU
5. Does the day of surgery matter for outcomes ?
operations performed on Fridays were associated with a higher 30-day
mortality rate than those performed on Mondays through Wednesdays:
2.94% vs. 2.18%;
Odds ratio, 1.36; 95% CI, 1.24–1.49)
6. March
27,
1977:
KLM
747-‐200
and
Pan
Am
747-‐100;
Tenerife,
Canary
Islands:
578
dead
7.
8. Collision
KLM
747-‐200
and
Pan
Am
747-‐100;
1977,
Tenerife,
Canary
Islands:
578
dead
contribu8ng
factors:
• bomb
threat
Las
Palmas
• poor
visibility
(mist)
• runway
ligh8ng
out
of
order
• airport
extremely
crowded
• (many
planes
parked
on
the
taxiways)
• impa8ence
/
hurry
/
irrita8on
(we’ve
waited
too
long….)
• ambiguous
communica8on
“you
are
‘cleared’ “
-‐-‐-‐
for
what?
“is
he
not
clear
then…?”
• Steep
hierarchy
gradient
• emergency
pa8ent
arrives
in
ER
-‐-‐>
OR
• anesthesia
understaffed
• OR
overbooked
• anesthesia
induc8on
takes
very
long
(we’ve
waited
too
long….
get
on
with
it)
• instruments
not
ready
• ambiguous
communica8on
I
thought
you
said:
‘give
protamine’.
….
• Steep
hierarchy
gradient
?
Recognize
this
?
9. Introduction to Human Factors
l ‘To say accidents are due to human failing is
like saying falls are due to gravity. It is true
but it does not help us prevent them’ Trevor
Kletz
l Human factors engineering is about
designing the workplace and the equipment
in it to accommodate for limitations of human
performance
11. Role of Human Factors
l User-Centered Design
l Systems designed to fit people (not vice-versa).
l Reduces training time.
l Minimizes human error.
l Improves comfort, safety, and productivity.
16. 16
FATIGUE MANAGEMENT
Anesthesia
and
fatigue
Australian
Incident
MonitotingStudy,
1987-‐1997
MORRIS
&
Morris,
Anaesth.Intensive Care
2000
Nature of incidents
Relative percentage of
advense events
ONo fatigue
OFatigue
5 10 15 20 25 30%
Fluid
error
Drug
error
Dose
error
Obstructions
17. Approaches to Problem-Solving
l Equipment Design – change physical equipment
l Task Design – change how task is accomplished
l Environmental Design – change features of the work
environment such as temperature, lighting, sound
l Training – change worker behavior by providing skills
and teaching procedures
l Selection – recognizes individual differences in ability to
accomplish work
18. “If an error is possible, someone will
make it. The designer must assume that
all possible errors will occur and design
so as to minimize the chance of the error
in the first place, or its effects once it
gets made”
Norman, The Design of Everyday
Things, 2001
19.
20. Congenital Heart Surgery and Human Factors
• Bristol Infirmary Inquiry report (2000): 30% of
children undergoing heart surgery were given
less than adequate care characterized by a lack
of communication, leadership, and teamwork
• Manitoba Pediatric Cardiac Inquest (2001) linked
human factors to less than adequate care
• Duke, heart-lung ABO incompatible transplant,
US
• Radboud Medical Centre, Nimegen, Netherlands
21. Congenital HD discharge mortality, 2011
l Ventricular septal defect (VSD) repair -- 0.6% (range, 0% to
5.1%),
l Tetralogy of Fallot (TOF) repair --1.1% (range, 0% to 16.7%),
l Complete atrioventricular canal repair (AVC)-- 2.2% (range, 0% to
20%),
l Arterial switch operation (ASO)-- 2.9% (range, 0% to 50%),
l ASO --VSD-- 7.0% (range, 0% to 100%),
l Fontan operation --1.3% (range, 0% to 9.1%),
l Truncus arteriosus repair-- 10.9% (0% to 100%),
l Norwood procedure-- 19.3% (range, 0% to 100%).
l Mortality rates between centers for the Norwood procedure, for
which the Bayesian-estimated range (95% probability interval)
after risk-adjustment was 7.0% (3.7% to 10.3%) to 41.6% (30.6%
to 57.2%).
Jacobs et al Ann Thorac Surg 2011;92:2184–92.
22. Pediatric Cardiac Surgery
A highly complex, low error-tolerant
l Highly dependent upon a sophisticated
organizational structure, coordinated efforts of
team members, and high levels of cognitive and
technical performance
l High-risk populations such as neonates in
particular, exhibit a fragile physiology
l Human factors, institution and surgeon-specific
volumes, complexity of cases, and systems
failures have been linked to variable outcomes
-deLeval 2000; Walsh 2001
23.
24. Research questions
l How do teams learn and recover so well?
l How do adverse conditions, mediated by team and
task processes, lead to negative outcomes (non-
routine events and negative team outcomes)?
l Can we reduce the negative outcomes by means of
an intervention focused at the team level (non-
technical skills) or through the conditions adjustment
loop?
30. Teamwork in the Cardiac
Operating Theatre
S
1A
SN
P
ACR
Perfusion
HLM
Anaesthetic
Workstation
2A
AR
Pumps
& Drips
Coding for
TEAMS:
S1=Primary
Surgeon,
S2=Assisting
Surgeon1
S3=Assisting
Surgeon2
A1=Anesthetist
A2=Anesthetic
Nurse
P1=Perfusionist
P2=Perfusionist
N1= Assisting
Nurse
N2=Circulating
Nurse
31. Observation Method
• 2 HF trained PHD observers
• Handwritten notes
• Scoring case complexity (1-25)
• Coding case outcome at discharge (1-4)
• Technical and non-technical skills
• High interrater reliability/kappy >0.7
Schraagen, JM, et al, 2010, 2011
32.
33. Observation Data
l 102 cases-Boston Children’s; U of Chicago and U of Miami
l 9/1/05 - 12/30/07
l 102 cases
l ~ 700 hours of observations
l @1300 annotated events
l ~ 70%: < 1 year old
l Mean case complexity - 11.7 (range 3.5-24.5)
l 42 cases, Netherlands
l 10/08-3/10
l 200 hours of observations
l Mean case complecity, 10.7
l 400 events
Galvan C, Bache E, Mohr J, Barach P. Progress Pediatric Cardiology,
2005;20:13-20.; Schrageen J, Barach P. 2009
34. My
‘Idiot’s
Guide’
to
Human
factors:
l ‘Hard
Stuff’:
l people
interacAng
with
machines
l People
interacAng
with
computers
l People
interacAng
with
automaAon
l ‘So_
Stuff’:
l People
working
with
people:
l Team
performance
l handovers
l Culture
35. Safety/learning at the “Coal Face”
l Initiation of bypass without sufficient heparin is catastrophic
l Hospital A
l Surgeon: Heparin please
l Anaesthetist: Okay, heparin
l Anaesthetist: Heparin going in
l Surgeon: Are we ready to go on bypass?
l Anaesthetist: Yes, ready
l Perfusionist: Yes, I’m ready
l Hospital B:
l Surgeon: Okay?
l Anaesthetist: Yes
l Surgeon: Alright then
“It’s fine if you know how we do it here.”
“About 6 months ago when we had
a bit of an incident with someone
new, but they weren’t here long.”
No recent heparin incidents
Catchpole K, 2011, in press
36. Process Mapping
l Ovals are beginnings and ends
l Boxes are steps or activities
l Diamonds are decision points
l Questions with yes/no answers
l Arrow indicates direction and sequence
37. 37Draft 4-2-04
Pediatric Cardiovascular Surgical Care
Our aim is to improve the process of cardiovascular surgical care, starting with
the child's referral for surgery and ending with the child's first post-discharge follow-up visit.
Cardiologist
Presents Case at
Cardiac Cath
Conference
Does Child
Need
Surgery?
Cardiologist
Notifies Child/
Family About
Surgery
Child Arrives for
Surgical Clinic
Visit
Child Arrives for
Pre-Op Hospital
Visit
Child Arrives for
Surgery (day of,
unless from NICU
or PICU)
(T, W, TH)
(H&P, pre-op teaching,
schedule surgery,
reserve room for
surgery )
Child and Family
Wait in Pre-op
Holding Room
(M400)
Transport child
to OR
Family to Surgical
Waiting Room
PICU Receives
Patient
Information From
Surgery, Via NP
PICU Receives
Multiple Updates
From Surgery,
Via NP
Report (what
happened in OR,
what lines, etc.)
OR team
transports child
to PICU
Child arrives in
PICU and is
stabilized
Discharged
Home (from
PICU,
Intermediate, or
Floor)
No
Surgery
Child has
Appointment with
Cardiologist
Cardiologist
Follows-Up with
Child/Family
Nurse Sets up
PICU
First Follow-Up in Clinic
(1-2 weeks post discharge)
Cardiologist
Makes Referral
for Surgery
NP Calls Family
to Answer
Questions and
Schedule Clinic
Visit
Yes
Diagnostic
Evaluation
Complete?
Completed while
Child on Table
Yes
No
Discharge
Planning Begins -
Case Managers
Pull Census
Report
Page 2
Page 3
Pre-op events
and initial
sedation
CHD detected
prenatally, in NICU,
by pediatrician, or
other modes of
presentation
RESULTS
Barach P. Anesthesia and Analgesia, 2007
38. Technical Aspects
l CTA based observational tool
l Checklist with narrative
Schraagen JM, et al, 2009.
39. Risk Mapping and Risk analysis
Main Prospective methods
l Work Domain Analysis
l Preliminary hazard analysis (PHA)
l Failure mode and effect analysis (FMEA)
l failure mode effect and criticality analysis
(FMECA)
l Hazard and operability study (HAZOP)
l Hazard analysis and critical control point
(HACCP)
l Probabilistic risk assessment (PRA)
39
Pascal
Bonnabry,
forum
Romand,
Lausanne
19.4.2005
40. Systems errors
l Adverse outcomes
l rarely have a single cause
l are the result of multiple system errors that
“line up” eventually to create a system failure
l Correction of system errors must focus on
the system processes, not the individuals
l A human factors engineering approach is
needed
l Improvement mediated thru the
microsystem
Carthey J, et al 2001; Catchpole K, et al 2007; Galvin C et al, 2005;
Barach P, et al 2008, Schraagen J, et al, 2010, 2011
41. Anesthesiologist meets with patient in surgical holding area
Pre-op events and premedication
Patient transported to OR
Patient enters OR
Insertion of lines and induction of anesthesia
Patient prepared for surgery
Incision
Dissection
Cannulation
Go on cardiopulmonary bypass (CPB)
Identification of structures
Surgical repair
Off CPB
Heparin reversed
Hemostasis
Chest closed
Prepare for move and update ICU
Team leaves with patient for ICU
Arrive at ICU
ICU nurses take over
Anesthesiologist or surgeon gives ICU attending report
Transport to OR
Pre-Surgery/
Anes. Induction
Surgery/Pre-
Bypass
Surgery/Bypass
Surgery/Post-
Bypass
Transport to ICU
Handoff
Process Flow Domain Major Events
2%
21%
12%
15%
45%
5%
0%
42. Major Team Failures
Paediatric Cardiac
l Swab causes compression of right coronary artery
l Ex-sanguination during post-bypass heamofiltering
l Omission of key surgical step
l Premature separation from bypass due to breakdown in teamwork
l Aortic homograft ruptured during sternotomy
l Incorrectly labeled homograft
l Difficult management of activated clotting time
Orthopaedics
l Multiple uncertainty leads to teamwork and task breakdown.
Examples of minor failures implicated in major failure sequences:
Communication/co-ordination failures in 5 out of 8 major failures
Absences in 4 out of 8 major failures
Equipment failures in 4 out of 8 major failures
Vigilance/awareness failures in 3 out of 8 major failures
43. Outcom
e N
Average
case
complexit
y
(Aristotle
score)
Average
length of
surgery
Average
No
of major
events/
case
Average No
of minor
events /case
1 50 10.5 200.7 1.06 15.3
2 7 14.3 190.3 1.23 17
3 9 13.6 174.9 1.00 13.6
4 4 18.7 330.1 2.25 11.5
Outcome scale: 1- excellent; 2-moderate ill; 3-severely ill; 4-death
Outcomes Related to Complexity and Number of
Events
.Bognar A, Bacha E, Nevo I, Ahmad A, Barach P. Society of Cardiovascular Anesthesia,
May 2005.
44. Fig. 4 The distribution of types of major events
0
5
10
15
C
ardiovascular
Ventilation
BleedingLine
Placem
ent
SurgicalTechn...
C
ardiopulm
onar...
Blood
P
roduct
C
om
m
unication...
C
ognitiveInstrum
ent
M
edication
Echo
SterilityM
onitoring
Transport
Type of the event
Numberofevents
Fig. 5 The distribution of types of minor events
0
100
200
300
C
om
m
unication...
Instrum
ent
Line
Placem
ent
SterilityC
ardiopulm
onar...
Transport
M
onitoring
C
ardiovascular
Ventilation
SurgicalTechn...
C
ognitiveM
edication
Blood
P
roduct
BleedingEcho
Type of the event
Numberofevent
Figure 4. 44% of
major events were
cardiovascular,
ventilation and
bleeding problems
(patient related
problems)
Figure 5. 44 % of
all minor events
communication/
coordination and
instrumentation
problems were
detected (not
patient related
problems)
Distribution of Major and Minor Events
45. Identifying non-technical skills
Current approach:
l Mini STAR, e.g.
l How well did you sleep last night?
l Are you well-prepared?
l Do you have any concerns about equipment, people,
process?
l Safety Culture Assessment (U. Chicago)
l Patient Safety statements
l Workload, staffing and supervision
l Communication in the OR
l Detailed process checklist paediatric cardiac
surgery
l Non-technical skills checklist (NOTECHS)
48. NOTECHS Tool – Part 2
2 dimensions (total 4)
Schraagen, JM, et al 2009, 2010
49. Conceptual model based on Reason’s model showing the role of the environment as a latent condition or
barrier to adverse events in health care settings.
Sources: Dickerman and Barach (2008); Joseph et al 2008; Patti and Barach (2011); Cassin and Barach
(2012); Sanchez and Barach (2012)
Socio-technical approach to safety and quality
50. Process Organisation
– Task Allocation
– Task sequence
– Discipline and composure
Teamwork
– Leadership
– Involvement
– Briefing
Threat and Error Management
– Checklists
– Predicting and Planning
– Situation Awareness
Lessons from Nuclear Power
and Aviation
Technology
Training Regimes
54. High Reliability Organizations
l Environment rich with potential for errors
l Unforgiving social and political environment
l Learning through experimentation difficult
l Complex processes
l Complex technology
Weick, KE and Sutcliffe, KM, 1999
55. Mindfulness and Safety in HRO’s
1. Preoccupation with failure
Regarding small, inconsequential errors as a
symptom that something is wrong; finding the
half-event
2. Sensitivity to operations
Paying attention to what’s happening on the front
line at the shop floor
3. Reluctance to simplify
Encouraging diversity in experience, perspective,
and opinion
4. Commitment to resilience
Developing capabilities to detect, contain, and
bounce-back from events that do occur
5. Deference to expertise
Pushing decision making down to the
person with the most related knowledge and
expertise
58. Human Factors Contributing to Mishaps
l Normalization of deviance
l Poor communication
l Production pressure
l Fatigue and stress
l Emergency operations
l Inadequate provider experience
l Inadequate familiarity with equipment, device, surgical procedure,
anesthetic technique
l Lack of skilled assistance or supervision
l Afferent overload (excess stimuli or noise)
l Normalcy bias (assuming alarms are ‘false alarms’
l Faulty or absent policy and procedures
Prielipp R, Anesthesia & Analgesia. 2010;110(5):1499-1502.
59. Apply human factors thinking to
your work environment
1. Human behaviour can be predicted with
reasonable accuracy
2. Avoid reliance on memory
3. Make things visible
4. Review and simplify processes
5. Standardize common processes and procedures
6. Routinely use checklists
7. Decrease the reliance on vigilance
60. “No matter how well equipment is
designed, no matter how sensible
regulations are, no matter how much
humans can excel in their
performance, they can never be
better than the system that bounds
them.”
Captain Daniel Maurino, Human Factors Coordinator
International Civil Aviation Organization