Lesson for patient safety taken from the aviation industry

The assigned reading for our Management class for this coming weekend includes The Checklist Manifesto, by Atul Gawande, a general surgeon. In essence the book is a narrative on the power of checklists as tool to avoid errors and deal with emergencies. Two central threads in the book involve 1) how the aviation industry has integrated this method into their safety training and culture with great success, and 2) the author’s experience in a WHO sponsored project to apply these lessons the surgical practice. The net is that after some trial and error, a clinical trial showed substantial reductions in major complications (36%) and deaths (47%) with use of the WHO checklist. The results were published in 2009 (A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population Alex B. Haynes, M.D. et al, Jan 29, 2009 New England Journal of Medicine). In the concluding chapters, the author discusses how little notice has been given to outcomes that otherwise would have generated headlines and had significant and widespread impact. By coincidence, last weeks lecture in Data, Information, and Knowledge Representation was on patient safety. Dr. Ferranti’s lecture gave the background issues and described efforts at Duke that are based on Informatic methods, use of CPOE and monitoring using both self reporting and keyword matching in HL7 messages transiting the Duke EMR ecosystem. The observed reductions at Duke were similar in level (30-45%) in several studies that he cited. One of the case study discussion questions (which we did not end up discussing) was application of methods from aviation to patient safety in hospitals. I wonder about the extent to which surgical checklists have been considered and tried at Duke.