Wellness & Fitness

Hospitals need aviation-type checklist to cut costly errors

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Kenyatta National Hospital in Nairobi. FILE PHOTO | NMG

In comparing the evolution of commercial aviation industry safety with healthcare in terms of accidents and fatalities, a lot can be gleaned from the former. This analysis becomes important due to potentially avoidable and eliminable causes of patient mortality and medical errors in our hospitals.

The subject of error reduction is gaining momentum globally both from medics and non-medics. Surgeon and author Atul Gowarde’s book Checklist Manifesto has become a global hit inspiring many. A recurring theme in such books is the question, “What can we learn and adopt from aviation rigorous flight checks to improve our patients’ safety?”

Globally hospital protocols have been in place for a while, their omission is why errors persist. Incidents like surgeries done on wrong patients, wrong limbs being amputated or wrong organs being removed are not uncommon.

These may seem comical errors from a layman’s perspective, but happen all over the world. However, removing the intensity, tension and urgency of medical interventions renders a wrong judgement on competency or mistakes.

Last week I attended a talk at the Amsterdam Health and Technology Institute (AHTI), where a session delved into the subject. The presenter drew comparison with a bearing on high fatality and accident ratios in the pre-checklist aviation era and how the latter gradually reduced them.

Statistically speaking, you are more likely to suffer harm during hospitalisation than taking a flight. This is a scary preposition given hospitals are meant to be sanctuaries of life.

How do we push local hospitals towards adopting and implementing checklists to seek perfection?

Closer home the inculcation of hospital mortality meetings is an important starting point towards this goal.

Last week’s court ruling affirming jurisdiction in medicolegal suits and another judgement making hospitals complicit for staff errors are wake up calls for administrators.

Human resource is critical in this agenda. Fatigue contributes to physician error and double shifts, inadequate rest, poor mental or psychological health as well as lack of close supervision of trainees are equally to blame. Staffing, equipment, competency protocols must all be part of the new “checklist manifesto”.

The latin words “primum non nocere”, translate to “first of all do no harm” remind us to aspire for the patients’ best benefit, always. Yet errors are not totally eliminable unless we stop intervening, which would lead to even higher fatalities.

We can strive towards attaining international best practice by keeping track of errors to learn from them. Think of it like the black box in aircraft crash. For this, we need an approach that does not seem like a guillotine over our heads when errors occur. This facilitates transparency.

“How do we ensure it never happens again?” is the advice Gowarde offers.

This article was inspired by AHTI’s medical researcher Martijn Kriens talk, “Patient safety: better safe than sorry”