The precise and intricate nature of surgery and the fast-paced, high-stakes nature of Formula One may seem as if they are worlds apart. But, back in 2007, a study was published in which surgeons from the Great Ormond Street Hospital (GOSH) took inspiration from Formula One pit stops to improve their surgical practices. At the GOSH, it was found that handovers from the surgical unit to the intensive care unit (ICU) were extremely erroneous. This led a doctor and a surgeon to contact Formula One teams and try to figure out what they were doing wrong.
What they learned revolutionised the way surgical handovers occurred.
What was going wrong?
Patient handovers involve transferring a patient and their information from one healthcare professional to another. This ensures that anyone who works with the patient is aware of how to take care of them, and of any problems that they may encounter. It is vital that a patient handover occurs accurately. But, in 2005, a study conducted at the GOSH found that around 70% of avoidable mistakes occurred during the handover procedure, specifically when handing over a patient from surgery to the ICU. Given the high-risk nature of a handover, something had to change.
After a subpar patient transfer, surgeon Martin Elliot and his colleague Allan Goldman managed to catch part of a Formula One race, and what captured their attention was the pit stop. Within a few seconds, the crew were able to change all four tyres, clean the vents, and adjust the front wing. Not only that, but the crew also seemed prepared for any situation thrown at them, whether that be a puncture or a weather change. In comparison, the patient handovers looked needlessly haphazard.
Visiting Formula One teams
With a willingness to learn the art of efficiency displayed during a Formula One pit stop, Elliot and Goldman contacted members of the British Formula One team, McLaren. This allowed them to learn the importance of small mistakes that may go unnoticed. Whilst minor, these errors can add up and have a large negative impact.
As well as contacting McLaren, the duo contacted the longstanding Formula One team Ferrari and travelled to their headquarters in Maranello. Here, they showed videos of their handover process to the technical director for feedback on what they could improve. The technical director was unimpressed, to say the least. He noted that there was no established hierarchy between the staff, no order in connecting and disconnecting equipment to a patient, and that several vital conversations were occurring simultaneously.
On the other hand, every person carrying out a pit stop had a defined role. For example, the ‘lollipop’ person is aware of their authoritative role of getting the car to stop in its pit box, and allowing the car to move away as quickly as possible, so as not to lose excessive time. Furthermore, the pit crew members underwent repetitive training to perfect their methods and reduce the number of mistakes made during a race.
Putting a plan in place
From the lessons learned whilst visiting Formula One teams, a new three-phase plan was put into place at the GOSH, in the hope of reducing the number of mistakes occurring at handovers.
Phase 0 consists of preparation for the handover. Thirty minutes before the handover, a patient transfer form is completed. Based on the information from this form, the receiving nurse sets up the monitoring systems and ventilation around the bed space.
Phase 1 involves the patient handover itself— the patient is connected to the relevant monitoring and ventilation systems. Safety checks then occur, and the receiving doctor and nurse signal their readiness to take over and care for the patient.
Phase 2 is for the handover of information. The anaesthetist and the surgeon will provide the necessary information about the patient, while the receiving doctor and nurse take down and use this information, and have the opportunity to ask appropriate questions.
Phase 3 is for planning ahead. The discussion moves from patient information to potential problems that may occur and how to solve them.
It is clear to see that the lessons learned from the Formula One teams have been incorporated into this three-phase plan. From the anticipation seen in phases 0 and 3, to the conscientious communication seen in phases 2 and 3, the detail-oriented nature of the pit stop was being emulated in the handover.
What improved after these changes?
The new handovers were monitored and assessed on four parameters: the number of errors that occurred during the handover; the number of omissions seen in the handover information; the duration of the handover; and how the staff worked as a team during the process. As well as this, psychologists analysed the handovers to determine changes in teamwork, leadership and situational awareness.
The new protocol saw errors reduce from 5.4 to 3.1 per handover, and information omissions reduced from 2.1 to 1.1 per handover. Furthermore, the improved team dynamics helped with the motivation to achieve fewer mistakes. The handover protocol could be easily learned in a 15–30-minute training session, meaning it was easy to implement in the hospital, especially given high staff turnover rates in healthcare.
However, not every aspect of a Formula One pit stop could be emulated in this protocol. Due to time constraints and scarce resources, rehearsals of the handover process were not possible. In addition, the unique demands of healthcare meant that not every scenario could be prepared for. Whilst a pit stop crew can plan to an extent what problems may come their way (like a puncture, contacting another car, or rain), this cannot be done in handovers. A plethora of things could go wrong, so it would be impossible to prepare for all situations.
Despite that, the study was seen as a large success. Whilst this was a small study conducted in one domain of the hospital, the promising results suggested that these methods could apply to other areas of medicine that involve handovers under intense time pressures. It even inspired similar studies, such as one that drew influences from the aviation industry to improve medical practices.
