Whether we have we gone too far in translating ideas from aviation to
patient safety is an interesting question but, as an anaesthetist and an
Airbus captain, I feel I have to agree with Dr Gaba that the answer is no;
in fact, I think we've hardly begun.
The checklist in aviation is but one manifestation of a system of
standard (and mandatory) processes, which have been developed over many
years and which are formalized in the airline operating manual. These,
together with the attention to team working and cognitive skills
introduced more recently, have been a major factor in creating and
maintaining safety in what is a complex and potentially hazardous
environment. That said, they are by no means perfect and their effect has
been somewhat eclipsed by parallel advances in the capability and
reliability of the technology.
The use of the WHO surgical checklist has undoubtedly prevented
errors, but its lasting value is more likely to lie in the effect is has
had in encouraging interaction among members of the team. In contrast to
the checklists used on the flight deck, the processes which lie behind the
items on the WHO checklist are frequently not standardized, formalized or
mandatory - at least not in any coherent form. So this checklist cannot
really be held up as an example of aviation practice implemented in
healthcare, and this is reflected in Dr Rogers' comments.
I don't believe that standardisation is an unrealistic aspiration in
the operating theatre, but the nettle of standardised methods of care in
general has not really been grasped by the medical profession, either to
embrace it or formally reject it. As Dr Gaba says, transfer of practices
from one domain to another will require translation: not all aviation
strategies will be applicable and those that are will require appropriate
modification.
The 'read and do' checklists that we use in aviation for abnormal
situations have their equivalent in our protocols for advanced life
support and anaesthetic events such as malignant hyperpyrexia, anaphylaxis
and 'can't intubate, can't ventilate' situations. In anaesthesia,
simulation of the type pioneered by Dr Gaba has allowed these and other
scenarios to be effectively rehearsed under quite realistic conditions.
Perhaps it is time now that our medical procedures, both normal and
abnormal, were extended in scope and embedded into a more formalized
system of care.
Finally, Dr Rogers alludes to the limitations of any system of
procedures and the importance of an underlying 'human factors' approach.
There are frequently marginal decisions to be made and traps for wary as
well as the unwary. Even the 'computerised monitoring systems' can become
one of these. In the recent incident when a Qantas Airbus A380 suffered an
uncontained engine failure, the crew were presented with over 50 warnings,
not all of them helpful, in the space of two minutes.
Rapid Response:
We've hardly started
Whether we have we gone too far in translating ideas from aviation to
patient safety is an interesting question but, as an anaesthetist and an
Airbus captain, I feel I have to agree with Dr Gaba that the answer is no;
in fact, I think we've hardly begun.
The checklist in aviation is but one manifestation of a system of
standard (and mandatory) processes, which have been developed over many
years and which are formalized in the airline operating manual. These,
together with the attention to team working and cognitive skills
introduced more recently, have been a major factor in creating and
maintaining safety in what is a complex and potentially hazardous
environment. That said, they are by no means perfect and their effect has
been somewhat eclipsed by parallel advances in the capability and
reliability of the technology.
The use of the WHO surgical checklist has undoubtedly prevented
errors, but its lasting value is more likely to lie in the effect is has
had in encouraging interaction among members of the team. In contrast to
the checklists used on the flight deck, the processes which lie behind the
items on the WHO checklist are frequently not standardized, formalized or
mandatory - at least not in any coherent form. So this checklist cannot
really be held up as an example of aviation practice implemented in
healthcare, and this is reflected in Dr Rogers' comments.
I don't believe that standardisation is an unrealistic aspiration in
the operating theatre, but the nettle of standardised methods of care in
general has not really been grasped by the medical profession, either to
embrace it or formally reject it. As Dr Gaba says, transfer of practices
from one domain to another will require translation: not all aviation
strategies will be applicable and those that are will require appropriate
modification.
The 'read and do' checklists that we use in aviation for abnormal
situations have their equivalent in our protocols for advanced life
support and anaesthetic events such as malignant hyperpyrexia, anaphylaxis
and 'can't intubate, can't ventilate' situations. In anaesthesia,
simulation of the type pioneered by Dr Gaba has allowed these and other
scenarios to be effectively rehearsed under quite realistic conditions.
Perhaps it is time now that our medical procedures, both normal and
abnormal, were extended in scope and embedded into a more formalized
system of care.
Finally, Dr Rogers alludes to the limitations of any system of
procedures and the importance of an underlying 'human factors' approach.
There are frequently marginal decisions to be made and traps for wary as
well as the unwary. Even the 'computerised monitoring systems' can become
one of these. In the recent incident when a Qantas Airbus A380 suffered an
uncontained engine failure, the crew were presented with over 50 warnings,
not all of them helpful, in the space of two minutes.
Competing interests: No competing interests