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PRB
February 14th, 2010, 06:48
Any medical people out there? What do you think of this?

I'm watching the news this morning, and they had a guest who wrote a book about how the use of checklists in hospitals that can, and evidently is, saving lives. The author/guest is the maker of the checklist and the promoter of the “movement” which is apparently “afoot” to make doctors use them. Simple checklists, such as “1) sterilize needle. 2) insert needle”. Step 1 being important that it be completed before step 2, you see... And also, presumably, check lists for more complex, but routine, procedures.

But what has this to do with flight sims and airplanes, you ask? Well, he says he has data to support the claim that hospitals using these checklists have fewer deaths in the operating rooms. But most interesting, is a story he tells about a hospital that said it was “using” his checklist system, but didn't report fewer instances of OR deaths. He asked the head nurse “would a brand new nurse be able to challenge a senior doctor in the OR if he failed to “complete step 3a”? The head nurse looked at him like he was crazy and said “heck no!!”

And this reminded me of the 1970s, when the whole “team concept” for flight crews in airlines began. Remember this? The imperious captain did not take orders from a mere co-pilot. The co-pilot will shut up and do as he is told, and he may not question anything the captain does! Co-pilot checklist: 1) The Captain Is Right. 2) If in doubt, refer to Step 1!

It is now “generally agreed” that the current “team concept” is “better” at preventing crashes than the old way, right? Because even imperious captians can make mistakes, and the rest of the flight crew should be able to feel like they can point that out of it happens without suffering the imperious wrath of The Captain (and/or crashing).

So this head nurse's story suggests the medical community might be able to learn a concept or two from the airline industry...

aeromed202
February 14th, 2010, 18:35
Some of my clinicals allowed me to see this sort of thing in practice. It actually worked fairly well, as long as it was reasonable and everyone believed in it. There was no step-wise kind of procedure for every hand motion but all eyes and heads were alert for an absence or omission. Before starting the patient was asked to confirm who they were and what they were here to have done, this was elective surgeries. A verbal accounting of people, instruments, supplies and tasks was then reviewed. Afterward instruments and supplies, used or not, were accounted for. There was no feeling of legal or beureaucratic pressure behind things. What they did was medically important and went smoothly every time. Anyone present could speak up if something was amiss, including me.
Emergent situations have a different approach. Everyone is trained and experienced at the skills to stabilize critical patients. It seems more chaotic but the notion that anyone can alert the team to something is the same. I've done it many times during the transfer from my care to the attending Doc in the ER. As soon as I can I attach myself to his side giving my report so I see what he sees and he can shoot questions without shouting.
I can easily see this concept being overdone, or worse dictated by a manager/lawyer with no medical background. But my experience has been positive. But in a plane I think the concept of a Captain, with experience, is necessary to correlate information and sometime be able to react on instinct.

MaddogK
February 14th, 2010, 19:50
But what has this to do with flight sims and airplanes, you ask? Well, he says he has data to support the claim that hospitals using these checklists have fewer deaths in the operating rooms. But most interesting, is a story he tells about a hospital that said it was “using” his checklist system, but didn't report fewer instances of OR deaths. He asked the head nurse “would a brand new nurse be able to challenge a senior doctor in the OR if he failed to “complete step 3a”? The head nurse looked at him like he was crazy and said “heck no!!”

Going by the number of stories my wife has told me over the years (she's a 'NIC-U' nurse, 30 + years on the floor) Id have to say that particular head nurse is either brown-nosing for a promotion, or she's just out of school. My wife claims quite a few lives saved by her interference with the doctors she's assisted over the years, and many of those doctors have thanked her for it. She says the main reason she's not a doctor is because of the mountains of paperwork she'd be responsible for, besides she loves her current responsibilities.