Friday, December 4, 2009

Near Misses by Air Traffic Control Still Better than Healthcare System

ABC News reported that two regional jets nearly collided before Thanksgiving near Denver when an air traffic controller accidentally told an approaching aircraft to make a u-turn into the other.

The error was both unbeknownst both pilot crews of the airplanes as well as the air traffic controller. Only 200 feet apart in altitude and less than 2 miles away, these planes flying at hundreds of miles per hour were within seconds of catastrophe.

What prevented this disaster so that it was simply a near miss? Two critical factors.

Computers in both cockpits alarmed imminent collision and advised immediate course of action. Pilots trained to trust the safety systems built to identify threats and problems and not question them.

Although human error is to blame for the near miss, it is clear that technology can assist to improve safety. Also, more importantly is that those using the systems need to have a mindset of trust and act accordingly even if it isn't immediately obvious why the action must be taken. As a result, the aviation industry is the leader when it comes to safety.

When it comes to patient safety, the healthcare system could do much better. Approximately 100,000 Americans die annually due to these preventable medical errors or errors of omission and missed opportunities. However, since these typically only occur one death at a time throughout the country no one seems to notice.

100,000 Americans is about 250 Boeing 747 jumbo jets filled to capacity. Imagine if that many crashed in a year. Would that get your attention?

These errors and omissions occur because doctors and hospitals lack the basic information technology for making patients safer. The vast majority of healthcare providers still use paper charts and handwritten prescription pads. Without a comprehensive electronic medical record which would help identify drug-drug interactions, avoid dispensing the wrong medication or dosage due to illegible handwriting, suggest the lab tests due for specific medical conditions, or prompting both doctors and patients when to get important screening tests done, all of us instead depend on our doctors and pharmacists never to make a mistake.

This is of course impossible.

So why doesn't the healthcare system do better?

Two simple reasons. First, the implementation of technology like electronic medical records is costly and no one wants to pay for it. For a doctor to implement an electronic medical record can easily cost $30,000. If it prevents a drug drug interaction or stops from having the wrong prescription dispensed, the patient benefits. Does the doctor or pharmacist benefit?

Second and perhaps the biggest challenge is in changing the mindset of doctors. Pilots and flight crews are trained to communicate and speak up regardless of their rank. Doctors, however, operate in a world with a set hierarchy and perspective that impedes safety. The pecking order still is medical student, intern, resident, fellow, and attending physician. Medical assistants, physician assistants, nurses, and doctors. Attending doctors tell residents what to do. Residents tell medical students what to do. Doctors tell support staff what to do.

As a result, the mindset becomes one of self reliance and a top down approach rather than one that values collaboration and team orientation. Rules, regulations, and computerized systems aren't going to tell a doctor what to do. This perspective explains why wrong side surgeries still occur and surgical instruments are left in patients even though surgical timeouts and checklists have been implemented in hospitals. Despite built-in safety systems and reminders in electronic medical systems which could help doctors provide better and safer care, doctors balk at the hassle factor of being slowed down or being prompted by a computer even though using paper charts they have more potential for serious harm.

The aviation industry takes safety seriously. When two Northwest airline pilots were using personal laptops in the cockpit which resulted it distracting them from their duties, being out of contact with air traffic control for 90 minutes, and resulted in them missing their destination airport, the airline suspended the pilots immediately while the FAA revoked their license.

The healthcare system says that it takes patient safety seriously, but do we? If doctors don't wash their hands routinely before every patient and every time, should physicians be suspended? Watch your doctor next time you see him. If he doesn't wash his hands, a simple yet important ritual to avoid spreading germs, then what other important steps might he be skipping?

The healthcare industry still has a long way to go in regards to patient safety. Until the mindset changes where doctors embrace systems and teamwork to prevent adverse outcomes which will invariably occur due to human errors and flaws, you'll be far safer flying than staying overnight in a hospital.

1 comment:

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