Designing a Chest Tube Checklist using a multidimensional human factor approach: a hierarchical task analysis, a failure mode and effect analysis and a Bow-tie analysis

Background Chest tubes are a standard procedure. Despite it being a regular intervention, complication rates can be up to 30 per cent, impacting patient’s health, morbidity and mortality. Checklists have been shown to reduce complications for other medical procedures. Data on implementing a checklist is increasing, while data on the development is still low. A guide on analysing and designing a chest tube accordingly has not yet been published. Therefore, the aim of the paper is to introduce a structured design of a Chest Tube Checklist based on analyses using human factor analysis tools. Methods A multifactor analysis was performed focusing on chest tube insertion and possible complications using hierarchical task analysis, a failure mode and effective analysis (FMEA) and a bow tie analysis. The data was collected through a workshop in addition to published literature on chest tube complications. Results The FMEA revealed events with a high level of risk priority numbers (RPNs). In total, 247 RPNs were calculated. Failure modes adding up to 147 RPNs were summarised as 'malposition of chest tube’. 'Lack of sterility’ accounted for 100 RPNs. The FMEA revealed the importance of indication, preparation, and equipment in assessing risk and ultimate failure. 'Malpositioning of chest tube’ was used for the bow-tie analysis. Contributing factors were extracted from the FMEA, preventative controls, recovery barriers and consequences analysed the lack of sterility was addressed by 'preventative controls’, recovery barriers and consequences in preparation, equipment, and chest tube insertion. Based on these findings, a checklist was designed. Conclusions Human factor analysis tools can be used to analyse procedure’s complications and its causes. Future data will need to show the effectiveness of the checklist.