Aviation-based training improves safety at 2 hospitals

A study finds increased use of incident reporting, preoperative checklists and improved communication after completion of "Lessons from the Cockpit."

By Kevin B. O'Reilly, amednews staff. Posted Jan. 8, 2010.

Training that draws on the lessons from aviation, particularly in interpersonal communication and decision-making, can have a positive effect on patient safety, a study found.

Aviation-based team training at two hospitals was associated with greater use of preoperative safety checklists. Physicians, nurses and other health professionals who took the six-hour training course also reported improved comfort levels on metrics of "empowerment," such as identifying and eliminating communication barriers and confronting mistakes and incompetence.

That sense of empowerment persisted for months afterward, according to the study, published in the December 2009 Archives of Surgery (archsurg.ama-assn.org/cgi/content/short/144/12/1133/).

The "Lessons from the Cockpit" course focuses on errors in aviation, how they compare with medical errors, and how so-called crew resource management techniques can help avoid them. More than 500 health professionals at Strong Memorial Hospital in Rochester, N.Y., took the course over six years, and preoperative checklist use during that time improved from 75% in 2002 to 100% in 2007 and after. Staff at Miriam Hospital in Providence, R.I., also took part in the study.

"The first thing we saw was when [the hospital] put the checklists in," said Harry C. Sax, MD, the study's lead author and professor of surgery at Brown University's Warren Alpert Medical School in Rhode Island. "The training increased awareness because people thought, 'Does it make sense? This works in other high-risk fields.' "

Dr. Sax has been paid for teaching some of the course work at Strong. He is an instrument-rated pilot who flies a single-engine plane as a hobby.

The two hospitals studied also saw safety-incident reporting increase from 709 each quarter in 2002 to 1,481 per quarter in 2008. Reports about unsafe hospital environments increased 27% during that period. This kind of situational awareness is a hallmark of aviation's approach and can help protect patients, Dr. Sax said.

"It is the difference between a situation where somebody picks up the phone and says the floor is wet, someone needs to dry it, versus picking up the phone and saying the floor is wet, someone slipped and fell," Dr. Sax said. "You acted on it before anyone was harmed."

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