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Aviation and healthcare: a comparative review with implications for patient safety, 2016, Kapur et al.

Discussion in 'General clinical care' started by SNT Gatchaman, Apr 4, 2023.

  1. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Aviation and healthcare: a comparative review with implications for patient safety
    Narinder Kapur; Anam Parand; Tayana Soukup; Tom Reader; Nick Sevdalis

    Safety in aviation has often been compared with safety in healthcare. Following a recent article in this journal, the UK government set up an Independent Patient Safety Investigation Service, to emulate a similar well-established body in aviation.

    On the basis of a detailed review of relevant publications that examine patient safety in the context of aviation practice, we have drawn up a table of comparative features and a conceptual framework for patient safety. Convergence and divergence of safety-related behaviours across aviation and healthcare were derived and documented. Key safety-related domains that emerged included Checklists, Training, Crew Resource Management, Sterile Cockpit, Investigation and Reporting of Incidents and Organisational Culture.

    We conclude that whilst healthcare has much to learn from aviation in certain key domains, the transfer of lessons from aviation to healthcare needs to be nuanced, with the specific characteristics and needs of healthcare borne in mind.

    On the basis of this review, it is recommended that healthcare should emulate aviation in its resourcing of staff who specialise in human factors and related psychological aspects of patient safety and staff wellbeing. Professional and post-qualification staff training could specifically include Cognitive Bias Avoidance Training, as this appears to play a key part in many errors relating to patient safety and staff wellbeing.

    Link | PDF (JRSM Open)
     
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  2. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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  3. RedFox

    RedFox Senior Member (Voting Rights)

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    Aviation safety drastically deviates from medical safety in that when a disaster occurs, even a highly unlikely one, they make immediate, sometimes extensive, changes to prevent it.

    The lack of standardization in medicine is certainly risky. Aeroflot Flight 821 comes to mind. See, the attitude indicator is a very important instrument on a plane. It tells you the current pitch (up/down) and roll (tilt side to side). It's the only way to get your bearings when flying through clouds. The standard western version shows you the horizon you'd see if you looked out your window, but the Soviet version shows you what someone following your plane would see. The pilot in this accident trained on the Soviet style and was flying a Western plane. When they lost control, him misreading the attitude indicator was a contributing factor to the crash.
     
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  4. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Counter example —

    There was a case a few years ago where a patient had both enteric and intravenous tubes/lines. The connectors were the same. If multiple, tubes should be clearly labelled and best practice is to trace the line by hand to confirm it enters the body where expected, before injecting. In this case that didn't happen and something designed to go into the gut went directly into the bloodstream with a bad outcome.

    The root cause analysis showed that it was both possible and in fact easy to attach a syringe full of something-for-the-gut to an IV line. Nevertheless, this was a very rare event (as far as we know).

    The result was a global recall of all gut devices, replacing them with uniquely coloured gear that can not connect to IV gear. The transition was a bit painful and we actually had a number of situations where we specifically wanted to use "IV" components with "gut" components for various things™ which we could no longer do. However, we adjusted and the world is a bit safer.
     
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  5. cassava7

    cassava7 Senior Member (Voting Rights)

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    Are those the ENFit connectors?
     
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  6. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Yes. I don't know the timeline in other countries and it's possible they've been in use for longer than Aus/NZ. A quick Google found this example page.
     
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  7. RedFox

    RedFox Senior Member (Voting Rights)

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    Yes, they're finally designing connectors to prevent situations like inadvertently putting feeding tube food into your IV. We've been using both of those for so long that you think it'd be standardized by now. If medicine was as willing to change as aviation, it would have been rectified the first time someone died or nearly died.
     
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  8. Amw66

    Amw66 Senior Member (Voting Rights)

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    @Barry has often compared these fields , and engineering.
     
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  9. Barry

    Barry Senior Member (Voting Rights)

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    This is very good, but omits something important regarding safety - the fact that Safety Engineering is a discipline in its own right, cutting across many other engineering disciplines, with its own specialised degree courses, and suitably qualified Safety Engineers being employed to advise/enforce adherence to the requisite safety engineering practices and standards. It may sound overblown, but if it did not happen then you can be assured the aircraft you fly in, and the vehicles you drive, would be massively less safe than they are.

    https://www.futurelearn.com/info/courses/intelligent-systems/0/steps/247632
     
    Last edited: Jun 9, 2023
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  10. Barry

    Barry Senior Member (Voting Rights)

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    Thank you for remembering that Amw66 :).

    Interestingly, I'm pretty sure the safety critical equipment used in hospitals etc. will be subject to very strict safety engineering standards, to minimise risk. I'm sure medical professionals would be very disconcerted if they were not. Is there a double standard here?
     
    Last edited: Jun 8, 2023
  11. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    I think that's a good point @Barry. Biomedical engineering has safety strongly promoted and enforced. Anything with human factors seems less so, particularly at a systemic level. Ie as long as everyone is singing from the same hymnbook (eg BPS theologians) there is no criticism or correction of an individual employing the failed model. The model simply is not assessed and recognised to be failed, due to lack of oversight.
     
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  12. Sean

    Sean Moderator Staff Member

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    Former medical electronics tech here. We had to run strict safety tests on all equipment before returning it to the ward/clinic, and sign for it on formal documentation that went on permanent record, meaning there was no dodging accountability for our mistakes.

    Not to mention being responsible for ensuring strict cross-infection control, our workshop being one of the primary locations within the health system where it could happen.

    Compare and contrast indeed. :grumpy:
     
  13. Barry

    Barry Senior Member (Voting Rights)

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    Absolutely. And the key takeaway from what you say, is accountability backed up by immutable audit trail.
     
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  14. JemPD

    JemPD Senior Member (Voting Rights)

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    I also thought of you straight away @Barry :) When i read the OP i went to tag you & saw you already seen it.

    I did wonder about 1 aspect in the chart though... where it says (under 'service users' section), that the doctors will know the patient well & know their families.... well, hmm, not so much these days, i mean thats what we all hope but it rarely happens, which imho is why a lot of errors/harm etc happen.

    The other thing that made me chuckle darkly was the it saying in the same section, that
    ... lol really?
    I mean thats what should happen & i dont doubt that sometimes it does, but one of the significant issues between patients/medicine is that often just the opposite occurs - with patients being dismissed and gaslit in order to avoid culpability/accountability.
    You only have to look at the mesh & maternity unit scandals to see how often that occurs. Not to mention ME patients & their families with patients being accused of FII & parents being referred to safeguarding when the GET made the kids worse.

    If only consultants, well all medical professionals, did console patients when things go wrong... to do that theyd have to admit the error in the first place!
     
  15. Barry

    Barry Senior Member (Voting Rights)

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    :)

    Hmmm, yes, from a bygone age that would be. Even the good doctors - and to be fair there are many - have far too little time allocated to each patient these days to get to know them much at all, let alone get to know them well! Especially if they don't see them very often anyway. And they have a far larger number of patients on their list, so much harder to get to know an individual. When I was a young kid, in the later '50s and early '60s, doctors came out to your home as a matter of course, and really did know you to some degree at least. NHS far too cash-strapped for any of that now.

    Yes, I think the word "generally" means many different things to many different people. They can also be incredibly unkind, unthinking and unempathetic. Someone I know with post-wartime issues has some very scary issues, with arm and neck issues, and worries about progressive deterioration. His carer in the end took him into A&E he was so concerned, and the consultant who saw him said that next time he would do better to go private for his healthcare. He told her that was impossible because he was on benefits, and it was like talking to a brick wall, she still kept saying he should go private, despite him telling her several times he was on benefits. Consolation my you-know-what!
     
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  16. JemPD

    JemPD Senior Member (Voting Rights)

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    Goodness thats awful!

    I was reading the comment 'when things go wrong' as meaning when mistakes are made - by said consultants, not when things are going wrong/are bad in the patients life/health separately.
    As its a paper about safety i was thinking 'when things go wrong' in the context of patient safety, ie when the consultant (or their colleagues) make a balls up of the surgery they just performed & you come to harm because of it. Or (as in a real life example you have had vaginal mesh used during a surgery which has done you tremendous harm - not the consultants personal fault but still a medical error even if unintentional. I read it like 'when mistakes happen the people responsible will console you'.

    I wasnt really talking about their level of kindness/empathy in general, but you are certainly right about that... IME of interactions with all kinds of health professionals over the yrs, that with any medic its a 50/50 chance if they will be compassionate/kind etc generally.

    I guess the point the chart is trying to make though, maybe is that whereas in a situation such as, say, a plane crash, the pilot has no personal relationship with any of the passengers on a one to one basis like a doctor does (albeit fleetingly).
     
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  17. Barry

    Barry Senior Member (Voting Rights)

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    I sometimes find it useful to look at extremes when trying to analyse something. So you could for example take a case of severe unempathetic (non-)care that directly leads to a vulnerable patient committing suicide. I think that would be a case where safety critical issues would come into play.
     
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