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Invited Commentary| Volume 144, ISSUE 1, P96-98, July 2008

Approaching process improvement from a human factors perspective: seeking leverage from a systems approach

      In this issue of Surgery, Shackford and colleagues
      • Shackford S.R.
      • Rogers F.B.
      • Terrien C.M.
      • et al.
      A 10-year analysis of venous thromboembolism on the surgical service: the effect of practice guidelines for prophylaxis.
      present the results of a most remarkable study. There are weaknesses to be sure, but they are far exceeded by the strengths. The authors have sustained a decade-long effort to reduce venous thromboembolism (VTE) on their surgery services through adoption of the guidelines for prophylaxis put forth by the American College of Chest Physicians (ACCP).
      • Geerts W.H.
      • Pineo G.F.
      • Heit J.A.
      • et al.
      Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
      In this report, they evaluate their success.
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      References

        • Shackford S.R.
        • Rogers F.B.
        • Terrien C.M.
        • et al.
        A 10-year analysis of venous thromboembolism on the surgical service: the effect of practice guidelines for prophylaxis.
        Surgery. 2008; 144: 3-11
        • Geerts W.H.
        • Pineo G.F.
        • Heit J.A.
        • et al.
        Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
        Chest. 2004; 126: 338S-400S
        • Reason J.
        Human Error.
        Cambridge University Press, Cambridge1990
      1. Kohn LT C.J. Donaldson M.S. To err is human: building a safer health system. National Academy Press, Washington D.C.2000
        • Shappell S.
        • Detwiler C.
        • Holcomb K.
        • et al.
        Human error and commercial aviation accidents: an analysis using the human factors analysis and classification system.
        Hum Factors. 2007; 49: 227-242
        • ElBardissi A.W.
        • Wiegmann D.A.
        • Dearani J.A.
        • et al.
        Application of the human factors analysis and classification system methodology to the cardiovascular surgery operating room.
        Ann Thorac Surg. 2007; 83 (discussion 1418–9): 1412-1418
        • Wiegmann D.A.
        • ElBardissi A.W.
        • Dearani J.A.
        • et al.
        Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.
        Surgery. 2007; 142: 658-665