You Have Control: aviation communication application for safety-critical times in surgery

Abstract

High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.

European Association of Oral Medicine 2021 Conference ‐ Crispian Scully Lecture: Applying Human Factors to Improve Patient Safety and Performance

“…We recommend the regular use of open questions, avoiding the use of pronouns (eg it, that) and repeat back at safety‐critical times. In this way, it can be confirmed that the message is not only heard but also understood by the receiver 25 …”

The role of human factors in improving patient safety

“…Aviation is totally different in that all essential communication is verbal so pilots and air traffic staff are trained to be clear with no ambiguity. We recommend repeat‐back at safety critical times so it can be confirmed that instructions are not only heard but understood by the receiver 9 . Open questions are also good and can enhance team working and empower others to be involved.…”

“…We recommend repeat-back at safety critical times so it can be confirmed that instructions are not only heard but understood by the receiver. 9 Open questions are also good and can enhance team working and empower others to be involved.…”

Applying human factors to improve patient safety, morale and team working for oral pathology and medicine specialists

“…The use of repeat back at safety-critical times (as happens in aviation) such that instructions are not only heard but understood by the receiver is good practice. 9 Open questions are also good and can enhance team working and empowering others to be involved.…”

“…During the COVID‐10 pandemic, the use of personal protective equipment (PPE) can result in verbal instructions and body language not being conferred to other team members. The use of repeat back at safety‐critical times (as happens in aviation) such that instructions are not only heard but understood by the receiver is good practice 9 . Open questions are also good and can enhance team working and empowering others to be involved.…”