As more details continue to emerge surrounding the sequence of events involving the heroic Hudson River splashdown of US Airways Flight 1549 in New York, the more the term miraculous seems an almost inadequate description of the outcome.
Looking for a safe landing
Use high-tech, low-tech solutions to help raise healthcare’s safety profile
While the entire flight crew and even the passengers deserve accolades, the lions share of the creditrightly sohas gone to Capt. Chesley Sully Sullenberger, who was at the controls and had little margin for error. It was his experience and skill in gliding the powerless airliner packed with fuel and 155 souls onboard that led to the happy ending. By all accounts, the Air Force and commercial aviation veteran has made safety his lifes work and obsession. Like all aviators, he trains constantly, and even owns a company that specializes in safety consulting.
News reports shortly after the accident gushed about aviation as an industry fixated with safety, leading me to wonder why such a label isnt more routinely attached to healthcare. After all, this is an industry all about healing, saving lives and, above all, doing no harm.
First, lets acknowledge, with no uncertainty, that in trauma centers, emergency rooms and operating suites across the country, teams of physicians, nurses and other caregivers routinely make equally dramatic saves every single day. Many of the cases are even more so. These are individuals every bit as dedicated to safety first as Capt. Sullenberger.
But what of the overall safety culture in medicine and healthcare? Here the industry falls short and is making scant progress in catching up. Otherwise, why do hospitals have trouble getting caregivers to routinely wash their hands? Why do surgeries still involve the wrong limb or the wrong body part? Why arent the proper medications given every time theyre prescribed according to best practices in medicine?
While these arent new problems, only recently did federal and private payers decide that enough is enough, and no longer would they pay for extra care resulting from so-called never events. Why did it take so long to discern that many tragic mistakes, common in healthcare, just shouldnt happen?
Whats aviations approach to safety? Training, training and more training, including long hours of simulation and heavy investment in technology. But is any of this lacking in healthcare? Aviation also has long depended on something else very simple and low-tech: checklists. Lots of checklists. Step-by-step procedures exist for a multitude of actions all with the goal of preventing errors. And they work.
Such checklists arent new to healthcare. Some are in use, but again theres a question of just why they arent universal. Part of the reason is that theyve sometimes been denigrated as mindless exercises or even cookbook medicine better reserved for fast-food franchises than modern medical centers.
The evidence is to the contrary. Just this month, according to a Jan. 14 special report published by the New England Journal of Medicine, a surgical checklist proved successful in reducing complications and death rates in a global study. Meanwhile, critical-care physician and checklist specialist Peter Pronovost also has achieved stunning results in using the lists to reduce infection rates. Just like in aviation, these things work.
Healthcare is about to be infused with tens of billions of dollars slated for information technology thanks to the largesse of the economic stimulus package nearing approval. Even President Barack Obama, in his inaugural address, vowed that the nation would use technology to improve the quality of healthcare. Hospitals, doctors offices and other facilities best find ways to install information systems that arent just receptacles of binary patient data but actually can aid caregivers in clinical decisionmaking and help eradicate grievous mistakes.
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