Maryn McKenna

Journalist and Author

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How hospitals are like cockpits

April 7, 2009 By Maryn Leave a Comment

We’ve talked a couple of times about the growing push for checklists in surgery and elsewhere in hospitals, promoted by Hopkins professor and MacArthur “genius” grant-winner Dr. Peter Provonost and modeled on the use of checklists in aviation. (This stuff interests me not just because it offers so much promise for MRSA reduction but because, as constant readers will remember, I am a pilot and am married to an avionics engineer.)

Provonost and colleagues have a very interesting piece in the current Health Affairs that takes another aviation concept — the Commercial Aviation Safety Team (CAST) — and applies it to medical errors. CAST is a public-private partnership from across the aviation spectrum — government, airlines, labor, manfacturers — that came together in the wake of several terrible accidents to do system-wide analyses of fail points. Provonost proposes that health care could vastly reduce errors by implementing a CAST model.

The cite is: Provonost, PJ, Goeschel CA, Olsen KL et al. Reducing Health Care Hazards: Lessons From The Commercial Aviation Safety Team. Health Affairs 28, no. 3 (2009): w479-w489 (published online 7 April 2009; 10.1377/hlthaff.28.3.w479)]

Filed Under: aviation, checklist, hospitals, medical errors, nosocomial

US Air 1549 and the relevance of checklists

January 19, 2009 By Maryn Leave a Comment

Constant readers, when we discussed the importance of surgical checklists last week, I mentioned parenthetically that I am a licensed pilot. (For av geeks: single engine, taildragger, VFR. And, just to complete the geekery, married to an avionics engineer.) So I’ve been particularly fascinated by the story and back-story of US Air flight 1549, which — as I am sure most of you know — bellied into the Hudson last week after losing both its engines to bird ingestion and landed beautifully, with no injuries to its passengers or crew.

The landing is being called a miracle, but to a pilot, it’s no miracle: It’s a testament to excellent performance under pressure by pilot-in-command Chesley “Sully” Sullenberger III and his first officer and crew. How did they perform so well? They ran down a checklist. Why did they reach for the checklist immediately, almost instinctively, and perform so well as a group? Because they trained many, many, many times to do exactly that.

Last week’s New England Journal of Medicine article made clear the value of checklists to medicine. But patient-safety analyst Bob Wachter asks an additional vital question: Even when medicine has such measures, how often do we train to implement them? The answer, he finds, is not often:

We need to continue to work, as aviation has for the past generation, to train our “pilots” to become Sullys. Because we in healthcare are flying over some pretty cold rivers, each and every day.

(Hat tip to KevinMD.com for calling attention to Wachter’s post.)

Filed Under: aviation, checklist, human factors, medical errors

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