University of California - UC Newsroom | Enhancing patient safety by improving communication

SACRAMENTO — A new program to enhance patient safety by improving communication in the operating room, based on training used in the aviation industry, will soon be under way at UC Davis Health System.

A key emphasis of the program is encouraging all members of the surgical team, regardless of their position, to speak up to prevent medical errors. The UC Office of the President is funding the program and making it available to all UC medical centers.

“The general philosophy underlying the training we are undertaking is that the OR is a stressful environment, much like a cockpit,” said Philip Schneider, director of perioperative services at UC Davis Health System. “A major thrust of the training is to instill respect for each member of the team as a co-equal. If junior members of the team notice something they believe must be addressed, such as a break in sterile techniques, or the failure to administer antibiotics prior to making an incision, they must feel empowered to say, 'This isn't right.'”

At UC Davis Medical Center, the training will unfold in stages. The first stage is a four-hour introduction to the training program for the leadership of perioperative services. A wider group of other key members of the surgical team will then undergo two days of training. This group will become advocates of the training, as well as instructors who will train the remainder of the staff.

After reviewing a number of proposals, the Office of the President, in consultation with physicians and hospital leaders, chose to contract with LifeWings, a system that was created by a former U.S. Navy pilot and modeled after the same training used to promote safety and reliability in aviation. Other LifeWings partners are physicians, nurses, pilots, former astronauts, physician executives and insurance experts.

Among the benefits the LifeWings program has produced in other institutions are:

The foundation of the LifeWings program's approach to achieving long-lasting improvements is effective communication that is formally structured and routinely performed in all surgeries. Schneider pointed to the regular use of a “surgical pause” as one way to enhance communication. During such a pause, the lead member of the surgical team delivers a summation of the case: who the patient is and what procedures are involved.

The decision to offer the LifeWings program to UC medical centers is based on the idea that common problems in the OR “could be ameliorated in a programmatic way, through scripted interactions,” Schneider said. The training will include simulated surgical cases and role-playing, with the entire process leading to a formalized method of interaction to be followed as a standard procedure for each surgery.

Schneider suggested that one element of that procedure might be an oral announcement, prior to the start of each operation, which would describe the surgical plan, the intent of the surgery, and the roles for each team member.

“The idea would be to ensure that everyone agrees on the plan and has a chance to air disagreements,” Schneider said. “Our primary goal is improving patient safety, with secondary goals of making some improvements in efficiency. We think we can make strides in this direction by encouraging more collegial relationships and reducing stress.”

Schneider thinks the new training program “will be embraced by surgeons because of the benefits it produces, and because that's what has happened elsewhere.”

The training is scheduled to last through February or March. The LifeWings program can be applied to areas other than the OR, and has been at other hospitals. They include obstetrics/gynecology, code teams, ICUs and anesthesiology emergencies.