Why Adapt Solutions from Other Industries

The pace of change and number of events that need monitoring in a high-velocity trauma center or large surgery facility with dozens of operating rooms make manual analysis and control of daily operations difficult, painful, and inefficient. Methods are needed to automate standard protocols, to monitor execution of processes, and to alert staff about required interventions. A useful metaphor for solving these problems is the introduction of the autopilot in the aircraft industry. Initially, autopilots were simple devices that kept the aircraft level and on course while the crew could pay attention to higher-level tasks. As flying became faster and more risky in aerial combat, terrain-following radar was introduced to drive an autopilot that would fly a fighter aircraft at the speed of sound at 500 ft in mountainous terrain at night. These systems have now evolved to full control of takeoff and landing of commercial airliners. The first Boeing test flights of new aircraft are done by autopilots to avoid risking the lives of crewmembers.

An interesting aspect of autopilots is that they operate by feedback mechanisms that cause small corrections back on course, so that large corrections are never needed. This is critical in health care where early, small interventions in patient treatment can often easily avoid disastrous outcomes. Interventions that are too late and require large corrections can be damaging and even fatal. An autopilot is needed to guide process execution for routine health care events, and warning lights and alarms need to be available just as they are for an aircraft pilot when an engine is overheating or a collision is immanent. Health care is in great need of an air traffic control system that assures operating rooms are ready, staff and equipment are in place, the patient is properly staged and prepped through the process, and beds and follow-up treatment are available when the patient clears the operating room.

As concerns about patient safety have grown, the health care sector has looked to other industries that have confronted similar challenges, in particular the airline industry. This industry learned long ago that information and clear communication are critical to the safe navigation of an airplane. To perform their jobs well and guide their planes safely to their destinations, pilots must communicate with the air traffic controller concerning their destinations and current circumstances (e.g., mechanical or other problems), their flight plans, and environmental factors (e.g., weather conditions) that could necessitate a change in course. Information must also pass seamlessly from one controller to another to ensure a safe and smooth journey for planes flying long distances; provide notification of airport delays or closures due to weather conditions; and enable rapid alert and response to an extenuating circumstance, such as a terrorist attack.

Institute of Medicine (US) Committee on Quality of Health Care in America [19]

In a perioperative setting, hundreds of patients and staff may be flowing through dozens of operating rooms on a daily basis in a single facility. A third of the patients are unscheduled and identified only on the day of surgery. The resulting chaos can be overwhelming, even with some form of electronic health record (EHR) system (currently available in 12% of hospital systems [38]). Orchestration of behavior between information systems is people and paper based. Available automated systems are often dedicated to isolated operations or departments with no automated means to communicate with one other. The limitations of this environment provide great opportunity for process improvement efforts. A 30% improvement can be routinely achieved in almost any targeted area and 100% improvements are possible [34].

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