March 28, 2011

To improve safety, health care needs to look at the aviation industry

In a commentary published March 2 in the Journal of the American Medical Association, a leading patient safety expert argues that failure to integrate new electronic equipment in modern hospital operating rooms and intensive care units results in diagnostic mistakes, failures to identify deteriorating patients, communication errors and inefficient work.

Clinicians are presented with an ever-increasing amount of raw data about patients, but with no single smart system to integrate that information, safety is not improving, say Peter Pronovost, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and Simon C. Mathews, a medical student at the university.

Pronovost says that hospitals need to collaborate with industry to create better systems that will meet clinicians’ needs, improve safety and reduce costs of care. He uses the example of “alarm fatigue,” the understanding that clinicians routinely ignore alarms due to noise overload and their perceived nuisance. Instead of equipment vendors working together to solve this problem, they  make louder and more annoying alarms to ensure that theirs get attention.

“As is frequently the case, the health care industry can learn from the experience of the aviation industry,” Pronovost and Mathews write. “When a major airline wants an aircraft for its fleet, it does not painstakingly assemble it by deciding which seats, control systems, engines, communications systems, oxygen masks and other components to use. The airline does not try to determine the best way for these and hundreds of other components to fit together; rather, it relies on an industry integrator (such as Boeing) to build a low-cost, high-quality aircraft that is safe and meets the needs of its end users. The result is a lower-cost, higher-quality airplane with components that work together. Health care needs a similar systems-integration approach.”

To read the JAMA commentary, “The Need for Systems Integration in Health Care,” go to