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Health Care Industry

Using aviation safety measures to enhance patient outcomes

AORN Journal, Jan, 2003 by Russell M. Rivers, Diane Swain, William R. Nixon

A recent report says that 44,000 to 98,000 Americans die each year as a result of medical errors. (1) This is the equivalent to more than 233 jumbo jets full of people crashing each year. In addition to human loss and suffering, it is estimated that medical errors cost consumers between $17 billion and $29 billion each year in additional care, lost wages, and litigation costs. (2) Consequently, methods of preventing medical errors and increasing patient safety in US medical institutions are being explored. In contrast to a two and one-half fold increase in the number of preventable deaths in medicine during the previous 10 years, the aviation industry has experienced a four-fold decrease in mishaps. In the past 20 years, the aviation industry has decreased errors caused by human factors 50% to 81% through safety training and standardization. (3) This article explores the potential benefits of applying these same safety training techniques and standardization practices to the health care arena.

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HEALTH CARE MEETS AVIATION

Methodist University Hospital (MUH) in Memphis is the base hospital for the Methodist Health Care System. In addition to the base hospital, there are three satellite acute care facilities, a pediatric specialty hospital, and three freestanding surgery centers. The base hospital has 33 multispecialty OR suites. During the past seven years, Methodist has experienced a substantial increase in demand at its facilities. With this increasing demand, many of the more experienced nurses opted to move to the satellite facilities closer to their homes. This migration led to the need to expand the pool of perioperative nurses within the system by increasing the number of new staff members in the perioperative training program.

Methodist University Hospital, located in the heart of the city, serves as the tertiary center for referrals of more complicated procedures in the tri-state area. These referrals, along with the hospital's affiliation with university teaching programs, make it a mecca of new technology and innovation. Additionally, MUH serves as a level-two trauma center. Consequently, it is an ideal training ground for its affiliated institutions, and it houses the core training program for all new nurses seeking perioperative experience in the system. After completion of the core program, nurses receive an orientation to the specific facilities where they will work.

In addition to the challenges associated with the constant learning curve related to innovations and technology, MUH also is challenged by a constant influx of new perioperative and medical staff members. Not unlike staff members at other facilities of its size, staff members at MUH must deal with ever changing instrumentation, increases in the number of multiple setups; a flood of new surgeons and techniques, and increased focus on productivity and turnover time reduction. The need for standardization of processes and communication techniques is paramount to help staff members balance changing demands while continuing to provide safe perioperative care.

During the early months of 2001, administrative staff members were working with a local consulting firm to identify ways to reduce the cycle time related to patient admissions. One consulting team member recently had been in contact with a local firm involved in aviation safety training. This firm was looking for a health care organization interested in exploring ways aviation safety principles could be used in health care.

WORKING TOGETHER

After several meetings between the two firms, Methodist Health Care agreed to allow the aviation training firm to spend time with surgical services staff members. The objective was to determine whether there were, in fact, similarities between the two industries and, if so, to evaluate the possible benefits of applying aviation safety training techniques to the surgical services staff member development plan.

Members of the aviation training firm introduced MUH surgical services management staff members to the concept of crew resource management. Crew resource management is a program of aviation safety training, team skills training, safety practices, and tools designed as countermeasures to decrease the number of aviation accidents. Crew resource management training equips pilots and crew members who operate in high-risk, stressful, error-intolerant environments with the team skills to communicate, react to adverse events, employ crosschecking behaviors, manage errors, and make effective decisions under stress. Successful crew resource management programs have been shown to reduce aviation mishaps between 50% and 81%2 The US military and militaries worldwide have used this training program.

At first, surgical services management team members were skeptical of the idea. How could anyone outside of health care understand the challenges faced by physicians and professional medical staff members caring for patients in life-threatening situations? They questioned how the aviation industry could teach them anything about safety and reducing errors and what the aviation and health care industries have in common.

Health Care Industry

Using aviation safety measures to enhance patient outcomes

AORN Journal, Jan, 2003 by Russell M. Rivers, Diane Swain, William R. Nixon

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