Patient safety experts see aviation group as model for health care

Patient safety experts have long touted the aviation industry's use of checklists and foolproof communication procedures as a model for how doctors and hospitals can reduce the toll of medical errors.

Now a group of prominent physicians and quality experts argues that health care should copy a voluntary public-private aviation safety partnership that has reduced fatal crashes by more than half since the mid-1990s.

The Commercial Aviation Safety Team -- formed in 1997 and composed of government agencies, plane manufacturers, pilots and airlines -- analyzes fatal crashes, and develops and prioritizes technological and other interventions.

The strategy could work in health care, said a group of experts from the Agency for Healthcare Research and Quality, the Joint Commission and Johns Hopkins University in Maryland, who proposed the idea in an April 7 Health Affairs Web-exclusive article (link).

"Health care is not aviation. That's abundantly clear," said Jerod M. Loeb, PhD, an article co-author and executive vice president of the Joint Commission's division of quality measurement and research. "Most of the solutions in aviation have had a technological component, but the cultural element is there too. It's the same thing in health care."

Many errors, for example, are due to problems in the design of medical products -- everything from catheters to defibrillators -- that make it easier for doctors and other health professionals to foul up under pressure. "Strong interventions," the authors wrote, "remove any reliance on memory or vigilance and eliminate (or greatly reduce) the potential to make the mistake."

The Joint Commission, AHRQ, the Food and Drug Administration, drug- and device-makers, insurers and organizations representing physicians and other health professionals should have key roles in the proposed safety partnership while the government pays the bill, the authors said. There is no price tag yet associated with the proposal. The Robert Wood Johnson Foundation has awarded a planning grant to an ad hoc group that includes the authors and 15 large health systems, with a report expected by the end of the year.

The Institute of Medicine has cited estimates that medical errors may kill as many as 100,000 Americans annually. A more centralized approach to the problem could better protect patients, Loeb said.

"We have to figure out what the most common contributory causes for an error are and plug some stoppers in there," Loeb said. "We can stop 80% of them from happening, but we will never prevent 100% of them."