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Hospitals learning safety lessons from aviation

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PostPosted: Wed Jan 10, 2007 10:10 pm    Post subject: Hospitals learning safety lessons from aviation Reply with quote

By Terri Yablonsky Stat
Special to the Tribune
Published January 9, 2007

A surgical team is about to wrap up a procedure. A scrub nurse notices that a sponge is missing. She hesitates, wondering whether to say anything. The surgeon is well known and highly regarded. Does she speak up and avoid a medical mishap? Aviation safety training may hold the answer.

Evanston Northwestern Healthcare is one of several hospitals taking a cue from the airline industry, training its OB/GYN staff in safety techniques used by cockpit crews. The step is intended to reduce hospital errors by eliminating the hierarchy in health care and improving staff communication.

When investigators listened to black-box recordings after aviation accidents in the late 1970s, they realized that part of the problem was people not speaking up in the cockpit. Human error is the culprit in many airline accidents, the same as with medical errors. And the resulting toll is heavy, with a 1999 report by the Institute of Medicine estimating that as many as 98,000 patients die annually from preventable medical errors. Some estimates are even higher.

The Evanston hospital began implementing aviation-based safety techniques Nov. 1. While some hospitals begin training after a bad outcome, the goal in Evanston was to be proactive and prevent errors, said Dr. Ian Grable, maternal and fetal medicine specialist. "The complexity of medicine has gotten so much greater that it's not possible to do it alone. It needs to be a team all working toward the same goal."

Safer Healthcare, a training and consulting company based in Denver, tailored a four-hour program for the Evanston staff. Over two weeks, all labor and delivery staff members completed the course, with plans to expand training to operating room staff this spring.

"The whole idea of crew resource management is that we all have expertise and know our jobs, but we don't work together as a team," Grable said. "In medicine as in the airline industry, there is a hierarchy. People don't question those who are more experienced. In the trenches of labor and delivery, we need to eliminate the hierarchy, work together, know each other's roles and be able to communicate on the same level."

The hospital now schedules team meetings throughout the day with all labor and delivery nurses, physicians, even secretaries. "We assess each patient's condition when they came in, where they are now, and make recommendations," Grable said. Staff members not only update others on their cases but learn what is happening on the unit as a whole.

Mistakes can happen when doctors don't communicate what they are thinking, Grable said. "They may be intensely focused on an issue but don't know what's happening around them. An example is when the anesthesia team and surgery are working independently. If something is not going well on the surgical side, then the anesthesiologist needs to know and make choices."

Training empowers every member of the team to communicate. In the sponge example, everyone hears the comment. If someone ignores the comment, the scrub nurse goes up her chain of command to the circulating nurse. "The scrub nurse must be able to say, `Wait, stop, I think there is a problem here,'" Grable said.

"It's a cultural change," said Peggy Ochoa, labor and delivery nurse with the Evanston hospital. "We have briefings and debriefings too. If something is difficult, we discuss it as a group. When you see medical mistakes, people don't talk about it. Our goal is that if there is a problem, it gets rectified and is talked about with all the people who need to know, and it's not going to happen again."

Other area hospitals using aviation-based safety techniques include Advocate Health Care, Children's Memorial Hospital, Highland Park Hospital and Northwestern Memorial Hospital.

Not everyone agrees that aviation safety translates to health care, however. "Aviation carries a kind of mystique that allows people to imagine that imitating pilot training will produce wonderful results," said Dr. Richard Cook, associate professor in the department of anesthesia and critical care and director of the cognitive technologies laboratory at the University of Chicago.

"We are still waiting for conclusive data saying that this specific type of aviation training makes the OR or hospital a safer place for patients," Cook said. "It's likely that these approaches can improve performance where it is already good. But it's far from clear that training conducted over a few days by a few highly paid consultants makes a great difference.

"I'm not saying you should not do these sorts of things," Cook continued. "But there is no magic here and no amount of feel-good training is going to make the issues related to the complexity and hazards of health care go away. There are lots of ways to make the system safer. This might be one. But what else are you doing?"
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