Learning from mistakes to improve patient safety and team functioning in the hybrid angiosuite

01 November 2020 → 31 December 2023
Research Foundation - Flanders (FWO)
Research disciplines
  • Medical and health sciences
    • General surgery
    • Vascular surgery
    • Occupational health and safety
    • Quality assurance
    • Vascular diseases
Patient safety Radiation safety Error management
Project description

During endovascular procedures, a high incidence of adverse events has been described, sometimes causing lifelong impairment and death. Are these caused by the patient’s condition, procedure’s complexity, or influenced by team members' psychosocial well-being, work environmental and/or organizational factors? Near-misses, errors, adverse events and patient outcomes will be analyzed during elective endovascular procedures in a hybrid angiosuite using the OR Black Box technology. Technical and non-technical skills of the endovascular team will be studied to characterize a chain of events, to detect areas of improvement and to identify high-risk interventions. Likewise, training of endovascular skills with its inherent learning curve is often associated with errors. By allowing surgical trainees to learn knowledge and endovascular technical skills in a safe, simulated environment using a stepwise, structured endovascular training curriculum prior to treat real patients, errors by surgical trainees may be reduced. Radiation is inevitably another major hazard for patients and healthcare personnel in the hybrid angiosuite. Radiation protection courses are often too theoretical to safely learn how to use X- rays in daily practice. A massive open online course including knowledge, examples of good and poor radiation protection behavior and serious game will be implemented and its impact on radiation safety behavior of the endovascular team will be studied using the OR Black Box.