The Doctors Who Sought Advice from Formula One
Applying the principles of “pit stops” to hospital care
My son has recently become interested in Formula One (F1). As we were watching a race together I suddenly remembered an article I had read about fifteen years ago about doctors applying F1 pit stop principles to medical care in hospitals. I couldn’t recall the actual details but thanks to Google and YouTube I found the story. As a Theatre Recovery nurse who used to work in Paediatric Intensive Care, I found it particularly interesting. I hope you do, too. Most of the information for this article was taken from this YouTube video. I’ve included links to a couple of websites, too.
In the early 2000’s, two senior doctors were relaxing in the staff room in the theatre department of Great Ormond Street Hospital for Children in London. One of the men, cardiac surgeon Martin Elliot, had just completed a twelve-hour operation — complex and intricate open-heart surgery on a baby. His friend and colleague Allan Goldman was a consultant in the Paediatric Cardiac Intensive Care Unit (PICU) to which the baby had just been transferred.
Although the surgery had been successful and the baby clinically stable, the transfer of the patient had been less than perfect. This was not unusual. Transferring children from the hospital’s cardiac theatre to intensive care was known to be the “weakest link" in the process.
The smooth, seamless teamwork that staff demonstrated during the anaesthesia and surgery would somehow become reduced to disorganisation and confusion in the short journey between departments.
Roles during transfer were unclear, technical problems were common and communication between theatre staff and PICU staff was often haphazard, leading to vital handover information being omitted. Nurses and doctors would be trying to make their voices heard through the chaos and it is reported that nurses receiving the handover were sometimes seen scribbling notes on their scrubs.
Errors regarding equipment were also occurring. For example, devices would inadvertently be left on battery power rather than being plugged into the mains in PICU, resulting in potential interruptions to vital drug infusions.
As the doctors relaxed on that particular day, they tuned in to a Formula One race on the staff room television. The men watched as one of the drivers drove his car into a pit stop where a highly trained team were waiting to recieve it. In less than seven seconds the crew had efficiently refuelled the car, changed four tyres, cleared the air intakes and sent it on its way.
Cars are no longer refuelled during F1 races, however in the early 2000s this was common practice. Seven seconds would now be considered very slow.
As Elliot and Goldman watched this impressive display, they were both hit by the same thought; why can’t hospital staff learn to be as efficient as pit stop teams?
This short video demonstrates the incredible efficiency of a modern pit stop crew:
The doctors knew without doubt that they had to follow up the concept with action. One of the PICU staff members had contacts in the McLaren F1 Team and invited director Dave von Ryan to Great Ormond Street Hospital to meet with the doctors. Ross Brawn, a director of the Ferarri Team, also became involved in the discussions.
Elliot and Goldman were not focused on the speed of the pit stop process; rather they were keen to learn how they could improve their staff’s efficiency, communication and teamwork thus reducing errors and improving patient safety.
Following these initial meetings, Elliot and Goldman sought funding from the Institute of Child Health and hired Dr Ken Catchpole, a Human Factors Researcher. Catchpole spent time with the doctors working on strategies to significantly improve the transfer process.
Elliot, Goldman and Catchpole were invited to Maranello, Italy, the home of the Ferrari team, to learn how to perform a pit stop while the F1 team were invited to do a hospital handover.
The F1 teams described the hospital team’s efforts as “clumsy and informal”, “inconsistent” with “simultaneous conversations”. They also highlighted that there was no rythm or order, and crucially, they couldn’t work out who was supposed to be in charge.
The F1 team also watched a video of a hospital transfer and were invited to give their opinion. Their verdict was clear; a shoddy, noisy, uncoordinated process with no clear leadership. They were shocked by the number of voices vying for attention and compared this to the absolute silence of the pit-stop crew at work.
The hospital team and members of the Ferrari team sat round a table for several hours discussing how to improve the process of transferring patients from theatre to PICU.
The following principles were learnt from F1 and are now rigorously applied to transfers and handovers in the hospital:
- Clear leadership
- Discipline
- Limited and structured speech
- Situational awareness
- Checklists
- Debriefs
The anaesthetist takes the lead during the transfer and hands over to the new lead — the intensivist (PICU doctor) who is taking over the baby’s medical care. This is done using a standardised, approved, logical format. Other team members are then invited to contribute to the handover in a timely and structured fashion.
According to Elliot’s presentation in this YouTube video, advice was also sought from a dancer. The hospital team realised that to prevent the staff getting in each other’s way, the process needed to be properly “choreographed”. Now each team member is assigned a specific role and knows exactly where to position themselves during the transfer.
Other vital elements of Formula One pit stops are training and repetition; principles which the hospital team also took on board. Rehearsals (simulations) were introduced into the department and were included in the induction programme for new theatre staff. These simulations include adverse events; with the nurses and doctors rehearsing the management of every possible scenario that might occur during transfers.
Formal debriefs are performed after every operation once the staff have returned to theatre following the patient transfer. The entire theatre team, no matter how junior, are strongly encouraged to participate in this process.
The principles that Elliot and Goldman learnt from Formula One are now standard procedures in many critical care departments across the UK and indeed in many hospitals all over the world.
Sources
https://gwern.net/doc/technology/2008-sower.pdf
https://www.thinkunthink.org/latest-unthinking/2020-03-31-how-f1-tech-saves-lives-a-personal-story
