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As deaths from Covid-19 drop sharply from previous highs, U.S. health care providers face yet another national emergency: deadly hospital errors. Estimate 150,000 patients every year.
Increasingly, Physicians and hospital Managers A full embrace of air-safety principles can be part of any solution. But many are rethinking how to make such efforts more effective than in the past.
Long before Covid-19 destroyed millions of families and pushed thousands of doctors and nurses to the breaking point, Medical leaders He wanted it. Learn A remarkable safety record from the airline industry to reduce the veritable epidemic of surgical and other medical errors. Now, with increased pressure on medical personnel, supply chains and safety measures, developing a new vision to reevaluate aviation practices to combat fatal medical errors seems more important than ever.
According to recent data, overall hospital safety has declined since the outbreak. Centers for Disease Control and Prevention Research Covering more than 2,900 hospitals, three months of 2020 saw a sharp increase in intravenous-related bloodstream infections compared to the same quarter in 2019. Research 148 HCA Healthcare-affiliated hospitals reported a significant increase in various healthcare-associated infections between March and September 2020.
Planned Domestic airlines have transported more than eight billion people without a single passenger in the past 13 years. fatality– Great performance beyond expectations. By contrast, hospital errors in the U.S. needlessly cost the lives of an estimated 400 patients every day, the equivalent of a packed jumbo jet every 24 hours.
What is the reason for this difference? Patriot Leaders From both. States They say healthcare has struggled to fully understand and interpret aviation security procedures to improve patient safety. Barriers include reliance on limited techniques such as reference lists, technical difficulties in sharing safety information across the industry, and cultural challenges in persuading veteran physicians to work as team players with junior doctors, nurses, and other hospital staff.
A few months ago, the Inspector General of the Department of Health and Human Services He came to the conclusion Hospital safety reforms have generally stalled, with Medicare patients experiencing preventable injuries or serious complications similar to those in 2008.
Three strategies to improve security
Professionals It indicates that the three basic elements of health care are not fully included. Strategies Trusted by their airlines and federal regulators: widespread voluntary reporting of serious incidents; Disseminate information quickly and widely about life-threatening emergencies; and user-friendly tool designs designed to prevent the same fatal mistakes from happening again.
in Responsefrom Capitol Hill From offices to hospital boardrooms, discussions are underway on how best to incorporate learning. An example is renewed Debate Creating a National Patient Safety Board modeled after the National Transportation Safety Board (NTSB), which investigates aviation accidents and makes public safety recommendations. Such a body could provide a framework for collecting and disseminating important information about medical errors.
Systematic deficiencies in hospital safety were highlighted in a seminal 1999 report by the Institute of Medicine, “Oh, it’s human.” that sparked the modern patient safety movement. Over the next two decades, Atul Gawande’s internationally acclaimed book, Checklist Manifestoand subsequent publications provided extensive coverage of aviation-derived precautions.
But health care must go beyond these first steps. An excessive focus on medical details, mimicking decades of aviation practice, often precludes reliance on newer and more effective safety techniques. Raj Ratwani, director of MedStar Health’s National Center for Humanities in Healthcare, said the benefits of checklists in medicine have been oversold. After initially embracing them over other security practices, physicians and hospital administrators have opted for more sophisticated security tools, including robust data sharing. Improved teamworkAnd more responsibilities for junior employees.
Non-punitive reporting
A non-punishable event Reporting And the rapid dissemination of details about dangerous “leaks” helped revolutionize modern air security. Very often, however, these concepts fail due to institutional reasons in the hospital Objection or fear of administrative retaliation.
David Mayer, head of safety research at Maryland-based MedStar Health, said that progress in reducing deaths by implementing air-safety practices “for almost all medical specialties” has been slow. “In terms of admitting and documenting mistakes, we’re still not where aviation is,” he said.
Christopher Hart, former chairman of the NTBB, explains clearly. “Information sharing in healthcare is pitiful compared to aviation.”
Kathleen Bartholomew, a former nurse and hospital manager, said encouraging transparency and reporting of medical errors “requires a big culture change,” but “this mindset has never caught on in most medicine.” “Nurses are getting fired for raising safety issues,” she added, adding that physicians are often reluctant to criticize their colleagues.
Incentives reported for safety during the recent trial of a former Tennessee nurse prompted national headlines. Radonda VautConvicted of two counts of drug abuse. Various health care organizations such as American Nurses Association and the American Hospital Association He expressed concern that criminalizing medical errors would further impede voluntary reporting and information sharing. (She was sentenced to three years probation.)
Data sharing
Medicine already has hundreds National And situation Registries that collect data on patient outcomes, complications and best practices. All are confidential and protected from legal discovery. In theory, the model is similar to the air-safety report.
However, unlike in aviation, there is no comprehensive database aimed at preventing hospital errors. If information often communicates well in digital silos, they will communicate with each other. Traditionally, accident data has been used by governments to fine hospitals for safety lapses — but only after problems have occurred. That encourages timely disclosure of errors, which translates into limited opportunities for ambitious data mining to find prerequisites, root causes, and necessary takeaways.
In general, the lack of urgent advice, in turn, can be quickly received by other health care providers. Instead, treatment feedback loops focus primarily on reporting adverse events. Without more voluntary reporting and in-depth data analysis, Professionals He said hospitals can find it difficult to implement effective and sustainable safety programs.
User-friendly medical equipment and technology
Moreover, healthcare has not followed aviation’s lead in incorporating human-centered technology. Modern jetliner cockpits are designed – and then evaluated before and after the aircraft enters service – to ensure that the automation they rely on is user-friendly. To date, this principle has not been universally adopted in operating rooms or other clinical settings.
“What I don’t see is that they’re designing tools and designing processes that make human error possible,” said Hart, a board member of the Joint Commission on Hospital Accreditation.
User-friendly medical devices combined with advanced electronic health records and predictive analytics can provide dramatic improvements in patient safety. Potential benefits include highly integrated cockpits and deep data analytics that could mimic the way airlines evolve. Security Since the late 1990s.
At this time, most hospitals are confident Software Designed to prevent mistakenly overdosing infants or providing adult patients with medications that should never be taken together. Another safety push involves installing switches and controls on different brands of devices, including defibrillators and infusion pumps, to install common designs to prevent staff confusion that could lead to serious mistakes.
Aircraft manufacturers and equipment suppliers, for their part, want to use artificial intelligence to identify potential hazards. Planned safeguards include, for example, autonomously identifying airports, conducting necessary radio communications, and landing and safely stopping aircraft on takeoff if pilot actions indicate confusion or incapacitation. Without any human intervention, future cockpits will perform emergency maneuvers to avoid deadly stalls and collisions with other aircraft, mountains, or even man-made obstacles.
According to Eric Horvitz, Microsoft’s chief science officer, the path could unlock innovation that “sleeps health care.” Technology companies And Hospitals They have already developed solutions to help identify patients who are often vulnerable or vulnerable.
Artificial Intelligence (AI) Winners Also point to current aviation technology that allows some pilots to digitally and video review their performance after their flight and compare it to other pilots. Similarly, some robotic surgeons use algorithms based on previous procedures to help them move the controls more efficiently. And more hospitals are tapping into AI networks to identify emergency room or intensive care needs for stroke or other life-threatening conditions.
But even here medicine seems to be following aviation strongly. Aircraft manufacturers have already introduced features that monitor pilot response and can unilaterally control flight control systems in critical situations. But physicians, no matter how advanced, continue to resist delegating or controlling patient procedures to computer networks.
Further complicating matters are AI-enabled software and tools. It is spread Time-saving, cost-effective, and more accurate solutions for complex medical procedures The Food and Drug Administration is playing host to fledgling police initiatives fraught with technical and ethical questions.
If the medical community never again demonstrates how reliable, time-tested aviation principles can enhance hospital safety, the current situation will represent many years of well-meaning discussions. What may be missing, however, are changes necessary to reduce the tragedy of fatal patient errors.
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