Surgeons, pilots trade safety ideas

The Baltimore Sun

Surgeons hoping to improve patient safety traded ideas yesterday with military pilots - trained professionals who also know a little about performing when the stakes are high.

In a hangar at BWI Marshall Airport, Navy pilots described efforts they take to ensure that stray objects don't get caught in their engines, that their every mistake is recorded and reviewed, and that they practice new tasks over and over on simulators before they attempt them in flight.

The parallels between surgery and aviation are gaining traction in an era in which doctors are under pressure to reduce medical mistakes that account for an estimated 100,000 deaths a year in the United States.

"Both work in a high-stakes environment where the tolerance for error is zero, and error can translate in very short order to fatality," said Dr. Adrian Park, chief of general surgery at the University of Maryland Medical Center, which sponsored the two-day forum that began yesterday.

At the same time, he acknowledged that the human body and mind are more complex than any aircraft. "The most sophisticated shuttle cannot approximate the complexity of human machines, but we believe there's a lot we can learn," he said.

Just a day earlier, the World Health Organization unveiled a "checklist for safer surgery" that was endorsed by 40 countries. Before an operation can begin, it requires that surgical personnel confirm the patient's identity, known allergies, the exact surgical site and the procedure to be performed. Afterward, they must make sure that all instruments, sponges and needles are accounted for and that specimens be labeled.

Dr. Atul Gawande, a Harvard surgeon who led development of the checklist, said his team followed the example of the aviation industry, which has long used checklists to avoid human error.

At yesterday's symposium, doctors saw a widely publicized example of what can happen through carelessness. An X-ray image projected on the screen showed a shiny retractor that had been left inside a patient's abdomen. Six months after the instrument was extracted, the patient is still recovering.

Dr. Carlos Godinez, a Navy pilot in a surgical fellowship at the University of Maryland Medical Center, noted that the crew of an aircraft carrier walk the flight deck several times a day, heads bowed, to search for stray washers, rocks, wire or bolts that could be sucked into an aircraft engine.

Like surgeons discussing their performance after each operation, pilots hear about their mistakes and near-misses after each flight. Not only do supervisors discuss what went wrong and how the pilots can improve, but electronic recorders also provide detailed evidence of what happened.

Godinez said the systems for reviewing and avoiding medical errors are "less codified" than systems to prevent mistakes in flight.

Navy pilots in training spend eight hours preparing for and reviewing a flight for every hour they spend in the air, said Navy Lt. Brian Colburn.

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