The dynamics at work in aviation and in surgery are strikingly similar. Both are high-risk professions carried out within highly complex systems populated with intelligent, type-A personalities. Two ideas that seem to be working in aviation that have cross-over relevance to surgery are briefings and standard operating procedures (SOPs).
In aviation, briefings before flights provide a forum that facilitates the building of teamwork, as well as clarifying who will be leading the team; opens up lines of communication; prepares team members for the flow of the task at hand; provides opportunities to discuss potential contingency plans; and reduces disruptive behavior by delineating expectations.
Expanding a timeout (in the OR) into a more comprehensive briefing can be very useful for bringing the entire operative team together as a unit. The team members might discuss and review any potential complications, the patient's risk factors and operative history, the anticipated stages of the procedure, and the coordination of switching to alternative procedures should the need arise.
In aviation, SOPs are considered to be the routine processes carried out because they have proven to be the most reliable protocols in the past. Checklists, as a part of SOPs, can be developed for high-risk departments within hospitals and serve a valuable purpose. Some surgeons may claim these instruments amount to “cookbook medicine.” If the function of checklists were to provide step-by-step descriptions of procedures that had to be followed to the letter, surgeons would be correct. However, it is an inaccurate description of the checklists to which we are referring. Checklists could be used in the operating theater as part of the preoperative preparation to ensure that all the necessary resources and equipment are on hand before the procedure begins. By ensuring that everything is in place before a procedure, surgical teams may increase the efficiency of an operation.
By creating an environment where team members communicate effectively using a number of tools such as assertiveness and rules of conduct, patient safety and quality of care are enhanced. Promotion of patient safety is a key component in the use of briefing checklists. It is a very effective and inexpensive process to implement that improves communication so that patient safety issues are covered before the procedures begin.
One tool currently used to guide briefings is a “key elements checklist,” which typically includes the
following action items:
- Get the person’s or group’s attention;
- Make eye contact;
- Introduce yourself;
- Use people’s first names;
- Ask knowable information;
- Provide information;
- Explicitly ask for input from all team members;
- Talk about next steps;
- Encourage ongoing monitoring and cross-checking.
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