Cath Lab Digest - December 2007 - (Page 37) 37 SICP Teamwork Spotlight The Relentless March of Interruptions Shirly Dawson Coffey, CVT Oregon Heart and Vascular Institute, Eugene, Oregon SICP Editor’s note: Shirly is an active member of the Oregon Chapter of the SICP (Society of Invasive Cardiovascular Professionals) and is writing a series of articles about teamwork. We hope you enjoy her work. A patient in the room is a given. Patience among the staff is not, and here is why. Constant interruptions, complete unpredictability and countless details. If you add these three things together, you come up with the wrenching and allconsuming frustration of even the most straightforward task. All any of us want to do is solve the problem at hand and complete the task with which we are presented. It is our job and our nature to finish what we start. However, with the above tortuous trio, the simplest task can bring you to your knees. Not even 24 hours prior to this writing, I was transporting a patient from our lab directly to the OR suite. Because of the multiple devices (the usual suspects) required to keep the patient alive, the four of us on call were not enough hands for the move. We incorporated help from down the hall as well as Respiratory Therapy, and began our trek. It took all six pairs of feet and hands to maneuver one desperately ill patient and 20 wheels down the hall. We lurched forward like some epileptic leviathan towards the elevator, all the while listening to the Lasix pump alarming. The message on the pump said there was air in the line, but an inspection revealed no reason for the alarm. We decided that it was: “Only Lasix, let’s keep going.” Then the balloon pump began to alarm, its message “inadequate augmentation.” We stopped to inspect all settings and connections, but could detect no problems. Unable to solve this problem, we deduced that the augmented pressure was sufficient to sustain life: “Let’s keep going,” and collectively decided that unless we saw vfib, we were not going to stop. Finally after a maze of corners and hallways, we reached the elevator, which you already know to be the most difficult portion of any in-house transport. I could say we “negotiated” all of those wheels into the elevator, but there was no negotiation involved. We bullied and coerced every single wheel. The Lasix continued to beep, the balloon pump was sounding and then the elevator began to alarm. For some reason, the “hold” button was not working and there began a loud, buzzing honk that drowned all other alarms and voices. As if we needed more stress during the struggle to get that last wheel out of the space between elevator and floor. Somehow, we were able to maintain enough slack in all the lines so we didn’t extubate or pull out the balloon pump and multiple arterial lines. After several jarring attempts at closing, the elevator door finally succeeded and we ascended. We arrived on the fifth floor, the elevator door opened and all of our noise and glory flooded into the hallway. I glanced towards the front desk to see a wideeyed attendant. When next I looked, she was gone. We eventually delivered our patient to fresh hands and made a hasty retreat to the relative calm of the cath lab. And there we did a good thing. We did a “team” thing. We sat down, stared blankly at each other for a moment, then burst out laughing. Our tension and frustration was released by the absurdity of the situation. We speculated that the front desk attendant was probably still running and visited a long list of hopeful disasters for the elevator. We shared good wishes for the patient who was, unknowingly, at the center of the whole ordeal. In doing these things, we downloaded the positive and off-loaded the negative. Just as all our actions were automatic in solving every difficulty throughout the case, we instinctively took time to recharge after the case. Yet right in the middle of this peaceful moment, the phone rang. Doesn’t it always! It was the physician of our next case asking why we had not begun his procedure. He was informed rather brusquely that we were taking 15 minutes for ourselves. He paused for a moment, then contributed his effort to our “team” by saying graciously, “Call me when you’re ready.” In that 15 minutes, we solidified ourselves as a caring and nurturing team. We revamped our energies, bonded as friends, then got up to do it all over again. The physician also played his part in not trying to hurry a frazzled group of people. We trusted him to be patient and he trusted us to take only the time we needed. It doesn’t always work out this way, but when it does, it is worth noting and remembering for future reference. I did some basic research on “work flow interruptions” and found data to support how frustrating constant interruptions can be, but as usual in my searches, I found nothing that addresses cath lab issues. We are simply too small a group to qualify for serious study. Other work forces had any number of studies from which to choose and I came across two which chronicled the unproductive results of being interrupted every 15 minutes!1 I’m not trying to invalidate the difficulties of other job fields, but if I could count on 15 minutes without an interruption, 80% of my workplace frustration would evaporate. Equally unhelpful was the advice I found to decrease interruptions. These being vague suggestions such as delegating tasks, micromanaging and time management skills, but the one I found truly comedic was to inform your co-workers that you are busy. I don’t care who you are; that’s just funny. No doubt, these solutions will work in many fields of employment, but not in a cath lab. The only research that approached cath lab-specific difficulties involved the ER or ICU and another that described a parent’s chaotic attempt to fix dinner with small children in the house. These studies laid out the minute-by-minute decisions and changes of course made during every task. When every step you take is determined by the outcome of the previous step, the most simple job can reach catastrophic proportions, with each element a potential domino ready to fell its neighbor. Consider the following examples: Every 5 minutes of flouro time, an alarm sounds that must be reset. All it takes is a moment to reach over or
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