testpanel/mac/pj2
CRM or its variant in the OR is something I have delved somewhat deeply into. I dont want to creep the thread off the Madrid incident but just want to point out a few things. testpanel... I for one am listening and its one of my main reasons for visiting this site as Ive learnt a lot from aviation safety and investigation in my professional capacity. In a very direct way I would like to challenge the comments of some who seem to feel that as some of us who post here are not pilots then we cannot add anything valuable to a discussion. Although I can just about work out which way is forward on an aircraft I am a professional at incident investigation and I feel that some of my views may be valid.
Should as nurse intervene during surgery? The short answer is that if an OR nurse has a responsibility for an action, such as a swab or needle count, if it is incorrect then the nurse is obligated to intervene. This may mean halting the surgery or preventing closure of the wound. (If its a nurse interrupting an operation to give her opinion on surgical technique, its different as the nurse isnt trained in surgery.) I cannot think of any parallels within aircrew where a FA can practically order a flight crew to take a particular action, but if you can enlighten me I would be grateful.
CRM in the OR is in its infancy but with aircrew its easy to recognise yourself as part of a cohesive team. This isnt necessarily so in the OR. The nursing staff may have more recognition of a team structure between themselves and not with the surgeon. Additionally within the same room and working on the same patient there is another medical and nursing team with diffierent practices, that is the Anaesthesiology team. Whilst in the main the different teams work towards a common end, the successful completion of surgery, there are often conficts, sometimes of a severe nature.
SOPs however are not well developed within the OR and there is much work to be done on that. It would go a long way to prevent wrong side/organ surgery, which as mac pointed out, is extremely rare anyway, but there are other examples where a checklist and a challenge/response system would be most useful. In my experience, the cultural/professional/training issues with clinical staff tend to make adoption of such a procedure difficult. Oddly enough within some well functioning teams in OR the challenge/response system seems to develop itself.
Valid reasons for a patient dying on the table? there may be many but it may be splitting hairs to say that a valid reason for a death may not mean that any procedure or professional competence is to blame. Although I accept that there are many variables with avaiation there are many with surgery. The surgery itself may be diagnostic and it is not uncommon for the diagnosis to be catastrophic. Some surgery is inherently very very risky... I'm thinking particularly about repairing ruptured aortic anerurysms which have 100% mortaility without surgery and about 90% with surgery. I cannot imagine a pilot attempting a takeoff with a 90% chance he will fail. I'm not being derogatory but pointing out that the decision making priorities may be different.