Translation of Aviation Safety Principles to Patient Safety in Surgery

Abstract

The aviation industry functions as a high-reliability organization that has used a variety of practices to maintain an enviable safety record, despite the inherent risks of flying. The inherent risks associated with air transport, the team structure of its aircrews, and the importance of a methodical approach in completing critical tasks, makes it in many ways similar to the perioperative setting. Using simulator training, line-oriented safety audits, check airmen, crew resource management, checklists, incident reporting, root cause analysis, and various communication strategies, the aviation industry has established itself as a leader in safety protocols to ensure high reliability. However, the safety record of surgery as a whole has not been so enviable.

As such, over the past few decades, there has been a gradual but steady move towards attempting to integrate aviation safety principles to improve perioperative patient safety. The use of crew resource management (CRM), incident reporting, checklists, and readbacks have been some of the most prominent principles that are slowly being adopted. The noted aviation author and former airline pilot, John Nance, has even written a book entitled “Why Hospitals Should Fly,” where he pushes for greater adoption of aviation-based practices to improve patient care and safety. However, much work needs to be done in continuing to assess the long-term effectiveness of these strategies to improve perioperative safety, given some significant differences in the aviation and medical/surgical industry. In this chapter, we cover some of the major aviation practices that are being applied perioperatively with accompanying studies, while touching on the current progress of cross-implementation, and also illustrating some of the criticisms in embracing the aviation model of high reliability.