Hospitals nationwide are placing a renewed emphasis on safety and The Nebraska Medical Center is at the forefront of this movement. The Nebraska Medical Center has joined an elite number of hospitals across the country that are training their staff with the same proven communication tools and safety processes adopted by the aviation industry over the last 25 years. Called crew resource management (CRM), hospitals expect that these processes, which have been attributed to helping reduce flight accidents and transform the aviation industry into one of the safest in the world, will do the same for the health care industry.

"The success of the CRM approach in the airline industry has made it one of the most effective safety programs ever launched," says Glenn Fosdick, president and CEO of The Nebraska Medical Center. "We think the application of those principles to patient care will do the same for health care. It’s part of our commitment to making The Nebraska Medical Center the safest and highest quality hospital in the country."

According to studies by the Institute of Medicine, the root cause behind medical errors appears to whittle down to something as simple, yet as critical, as effective communications. The goal of CRM is to improve communication among health care teams that will translate into fewer errors and the loss of fewer lives. When CRM was developed more than 25 years ago, the majority of airline accidents, as many as 70 percent, were caused by failures in communication among crew members. CRM set out to standardize communication and teamwork and resulted in significant improvements in aviation errors and safety.

CRM brings a set of skills and processes to medicine that in some cases, didn’t exist, or in other cases, needed to be formalized and standardized. These include the introduction of safety tools such as standardized presurgical routines, protocols, debriefings and check lists that can be performed prior to surgery, before patient rounds or during hand-offs with the intention of detecting and preventing small errors before they become more serious.

How can aviation-based safety practices work in the health care setting? There are actually many striking parallels between the airplane cockpit and the operating room or emergency department. For instance, flight crews and physicians and other healthcare staff are highly trained professionals working in complex and technically demanding situations. In both places, routine decisions have life and death consequences. In both settings, the team members are sometimes strangers. In the OR, like the cockpit, there are a large number of professionals trained in a variety of disciplines. In both places, there is a lead professional who sets the tone of the team’s work. And in both places, fatigue and routine can be the enemy of precision.

The Nebraska Medical Center has implemented the CRM program in its operating rooms and continues to train additional staff and will eventually adapt the processes to all procedure-based areas in the hospital.

Taking Safety to New Levels

The adoption of CRM is just one way in which The Nebraska Medical Center is striving to make its medical facility one of the safest in the country. Over the past few years, The Nebraska Medical Center has participated in a number of safety initiatives. A snapshot of these include:

• Institutes of Medicine’s 100,000 Lives Campaign - The campaign focuses on implementing changes in care in six key areas that have been proven to prevent avoidable death. These include: deploy Rapid Response Teams at the first sign of patient decline; deliver reliable, evidence-based care for acute myocardial infarction to prevent deaths from heart attack; prevent adverse drug events (ADEs) by implementing medication reconciliation; prevent central line infections by implementing a series of interdependent, scientifically grounded steps called the "central line bundle;" prevent surgical site infections by reliably delivering the correct perioperative care; and prevent ventilator-associated pneumonia by implementing a series of interdependent, scientifically grounded steps called the "ventilator bundle."
• Joint Commission on Accreditation of Health Care Organizations’ Patient Safety Goals - These goals promote specific improvements in patient safety and highlight problematic areas in health care with expert-based solutions to these problems. Organizations are evaluated for continuous compliance with the specific requirements associated with the National Patient Safety Goals in order to maintain accreditation by The Joint Commission.
• The Centers for Medicare and Medicaid Services Hospital Quality Initiative - Its goal is to improve the care provided by the nation’s hospitals and to provide quality information to consumers and others. Participating hospitals provide reports on 20 measures of hospital quality of care in the areas of heart attack, heart failure, pneumonia, and the prevention of surgical infections. More than 4000 hospitals have voluntarily reported data on quality of care provided from October 2004 through September 2005.
• National Quality Forum’s 30 best practices - With support from the Agency for Healthcare Research and Quality (AHRQ), National Quality Forum has identified 30 safe practices that evidence shows can work to reduce or prevent adverse events and medical errors.
• Leapfrog Group Hospital Quality and Safety Survey - A program that rates participating hospitals with a "quality index" based on the hospital’s implementation of 27 procedures that have been shown to reduce preventable medical mistakes as well as initiation of three major initiatives involving evidence-based referrals,