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F1 and GOSH - where motorsport and medicine meet 01 Jul 2008

McLaren's Lewis Hamilton (right) meets Great Ormond Street Children's Hospital (GOSH) patient Graham Reading (centre) at the 2007 British Grand Prix. © GOSH Felipe Massa (BRA) Ferrari F2008 makes a pit stop.
Malaysian Grand Prix, Rd 2, Race, Sepang, Malaysia, Sunday, 23 March 2008 Poster for Ferrari from GOSH.(Great Ormond Street Hospital) Formula One World Championship, Rd 9, British Grand Prix, Race Day, Silverstone, England, Sunday 8 July 2007. World © Sutton Lewis Hamilton (GBR) McLaren and Pedro de la Rosa (ESP) McLaren Test Driver with children from GOSH.
Formula One World Championship, Rd 9, British Grand Prix, Qualifying Day, Silverstone, England, Saturday, 7 July 2007 Heikki Kovalainen (FIN) Mclaren MP4/23 makes a pitstop.
Malaysian Grand Prix, Rd 2, Race, Sepang, Malaysia, Sunday, 23 March 2008

Once a year, ahead of the British Grand Prix, Formula One racing dusts off its glad rags and hosts an official party in aid of London’s Great Ormond Street Hospital (GOSH) Children’s Charity. The event, which last year raised over £350,000, attracts the cream of the paddock’s glitterati, as well as a host of celebrities.

But in addition to boosting the hospital’s coffers, Formula One racing has also lent a helping hand to Great Ormond Street in an altogether unexpected way. A cunning idea thought up one Sunday afternoon by two doctors watching a Grand Prix on television has led to the unlikeliest of collaborations.

One of the most perilous points when caring for the seriously ill is the handover between surgery and intensive care. As each moment ticks by on the transfer from operating table to ward bed, the risk to the patient increases. It’s an age-old issue, but one that the doctors at Great Ormond Street were determined to improve.

After seeing several of his patients falter during handover, paediatric heart surgeon Professor Marc de Leval was particularly concerned. In an effort to understand why, he recruited a team of ‘human factor specialists’ to assess a number of arterial-switch operations, a procedure designed to fix a congenital heart defect in newborn babies and one which can be particularly fraught with difficulties.

Leval’s study suggested that it was the handover process that was letting the side down. How the hospital could improve its handovers, however, remained largely unresolved until two members of Great Ormond Street’s staff found themselves relaxing in front of a Formula One race on TV after a particularly hard day at work.

“Two of us are F1 fans and we were sitting one Sunday, after a transplant, watching a Grand Prix,” explained Dr Allan Goldman, head of the hospital’s paediatric cardiac intensive care unit. “My colleague Professor Elliot, who is a surgeon, remarked that when you look at a Formula One pit stop, how they all get together is really the epitome of how a team can reconfigure into a functional unit.”

From quick reactions at the start, to optimal acceleration and late braking - efficiency is central to the outcome of a Formula One race. And this need for clear organization and swift reactions is clearest of all during a pit-stop, when crews of 20 highly-trained individuals come together to refuel, re-tyre and fine-tune a car to get it back out on the race track within a matter of seconds.

For Goldman and Elliott the parallels between this and their own challenges were striking. Both involved multiple specialists simultaneously carrying out numerous, complex tasks - tasks that frequently involved complex interfaces, and which all had to be completed quickly and accurately. Upon this realisation the duo quickly set about contacting Formula One teams to ask them to lend their expertise and help the hospital streamline their processes during a patient handover.

“Initially we went to the McLaren team and then later on we also worked with Ferrari,” explained Dr Goldman. “We spoke about leadership and how to organise the process, who was in charge, rhythm, task allocation, checklists, all of which aren’t well embedded into medicine. They were all very simple things, but they were just not part of our culture.”

Senior technical people from both Formula One squads visited the hospital to observe and evaluate Goldman and Elliott’s teams in action, while the duo travelled to Ferrari’s Italian base in Maranello, and also attended the British Grand Prix to observe the perfect choreography of pit stops at first hand.

From a specially designed trolley to a new systematic protocol, suggestions came flooding in thick and fast. And with lessons duly learnt, the pair returned to London with a raft of ideas from which they then cherry picked the best and most appropriate for their needs.

Although practical considerations meant not all could ultimately be adopted, the team at Great Ormond’s Street did employ the lion’s share, including the implementation of a clear chain of command and the adoption of clear contingency plans. The effects of this new protocol on the hospital’s success rate were impressive.

“They’re trying to achieve excellence in winning races, and we’re trying to achieve excellence in patient outcome,” explained Goldman. “Our errors went down by about 30 percent or so. The key thing we found though was that there was a reduction in multiple errors. You notice when you see clips of Formula One that when things go wrong, like a fuel hose gets stuck, the little errors add up and cascade into a major failure.

“It was the same with us and we were very pleased that it caused a reduction of multiple errors. It (the handover process) also takes a shorter time, although that wasn’t our aim. In Formula One it is about quickness - every second counts - but for us it is about safety.”

Not only has the project had a very real effect on the lives of Great Ormond Street’s many patients, it has also received a great deal of attention from within the UK medical community and beyond, with hospitals from around the world eager to discover more about the hospital’s new Formula One-inspired methodology.

“It really has caught the imagination,” added Goldman, who is eager to expand the project still further. “The challenge is keeping it going. In house, people slip back. And we are still interested in generating more interest from other (Formula One) teams - we still have other areas which we want to look into!”

For more information on the Great Ormond Street Hospital Children’s Charity and this week’s official F1 Party, including your chance to bid on some very special auction items, visit www.gosh.org/f1party