Head To Head

Have we gone too far in translating ideas from aviation to patient safety? Yes

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c7309 (Published 14 January 2011) Cite this as: BMJ 2011;342:c7309
  1. James Rogers, consultant anaesthetist and flying instructor
  1. 1Department of Anaesthesia, Frenchay Hospital, Bristol BS16 1LE, UK
  1. jrogers@bristol61.fsnet.co.uk

James Rogers thinks that attempts to learn from aviation are ignoring fundamental factors in healthcare, but David Gaba (doi:10.1136/bmj.c7310) argues that much more could be done

Why are doctors constantly told to adopt aviation safety practices? My own specialty of anaesthesia is particularly vulnerable, based on the dubious analogy that giving an anaesthetic is similar to flying an aircraft. Although initiatives such as the World Health Organization’s surgical safety checklist are generally welcome, the aviation model has only a limited place in medicine because there are fundamental differences between the ways in which doctors and pilots work.

Using a checklist should never detract from the priorities of flying an aircraft or looking after a patient safely. Immediate actions should be committed to memory, followed by reference to a concise aide memoire. Crucially, a checklist is distinct from a briefing, which is normally given at two specific times during a flight—before departure and before descent. A briefing deals with all the “what ifs?”(where to divert to in bad weather, what to do if an engine fails on take-off) and deliberately takes place at a time in flight when workload is relatively low. In the operating theatre the checklist and briefing have merged untidily— team introductions, discussions, and concerns are integral to a …

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