# Surgery safety : The operating techniques learned from pilots - BBC News



## Yrys (24 Jan 2009)

The lessons pilots can teach surgeons







Before take-off, every pilot needs to brief their crew about what to expect. At the 
end of each flight, they talk briefly about what went right, what went wrong and 
what could be done better.

Pilots say this brief and debrief system has reduced errors and made flying safer, 
and a growing number of NHS medics think this system should be adapted - to 
make surgery safer.

*Avoiding errors*

A report by researchers at the University of York claims that accidents, errors 
and mishaps in hospital affect as many as one in 10 in-patients - but that up 
to half of these were preventable.

One doctor who has trialled the brief and debrief system in two units at his 
hospital says incidents were reduced by between 30-50% over the period they 
used it. Mr Peter McCulloch, a surgeon at Oxford's John Radcliffe Hospital, said 
his experience showed the system worked - but there was some resistance 
within the NHS.

"Various people in various parts of the country are trying to introduce this kind 
of team training and Scotland are actually ahead of England in this. "But it runs 
crossways to our culture and training. "We are trained to believe that we know 
what is going on, take the major decisions and keep an eye on everything, which 
is impossible for any human being.

"If you have been trained in this culture that instils in you that everything is your 
decision and responsibility, and it is very hard to stop and listen to your junior 
trainee who might tell you that you are doing something wrong."

*Briefing procedure*

He said they had introduced the briefing technique in surgery to prevent recurrent 
strokes, where a blocked artery in the neck is cleared, and keyhole gall bladder 
surgery.

"We have had episodes where we have done a briefing for a procedure that 
required a certain piece of equipment, and the theatre nurse has said 'Mr X 
has that so you can't'.

"Without the briefing we might have found that out halfway through the operation 
and been really stuck, and we would have either had to open the patient up or 
delay. "I also know of cases for surgery to prevent strokes where the anaesthetist 
was just about to give the wrong drug, which would have been potentially fatal, 
but one of the team piped up and said not to do it.

"Everybody must do team-work training in the air industry right from being a baby 
pilot in training - we are only at the start of that process in surgery, but I think it 
is an exciting prospect if we could get this built into the system."

*Team work*

Trevor Dale, a retired airline pilot and trainer said: "For airline pilots team work is 
mandatory and has been for several years. "We must do what we call 'crew 
management resource training' and airline pilots can effectively terminate their 
career if they can't work effectively in a team.

"There is quite a large movement in attempting to use this style of training message 
for healthcare. "In aviation before every take-off and every landing the crew, and 
sometimes the cabin crew, will discuss what to do if all goes well and how to deal 
with any unplanned emergencies that can conceivably go wrong.

"They are trying to get everything sorted out in advance. "Operating theatre teams 
generally don't do that, so when they are faced with problems -which they almost 
inevitably are, making assumptions about what to do can be very dangerous."

John Black president of the Royal College of Surgeons, said it is vital that the whole 
operating team work together. "The college takes best practice from many other 
industries and applies it to surgical training. Being a good team-leader is not just 
about what the surgeon does but about ensuring that the whole team works effectively." 


That could help with that : Hospitals (Canadians) reusing single-use devices: survey - PC


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