Doctors use Formula One pit crews as a safety model
First it was aviation, then the Toyota assembly line. Now doctors are looking to auto-racing pit crews for ways to improve health care quality and patient safety. Hospitals in at least a dozen countries, including the United States, are learning how to translate the split-second timing and near-perfect synchronisation of Formula One pit crews, who can refuel a car and change all four tyres in seven seconds, to the high-risk handoffs of patients from surgery to recovery and intensive care.
By Dr Lesley Russel
First it was aviation, then the Toyota assembly line. Now doctors are looking to auto-racing pit crews for ways to improve health care quality and patient safety.
Hospitals in at least a dozen countries, including the United States, are learning how to translate the split-second timing and near-perfect synchronisation of Formula One pit crews, who can refuel a car and change all four tyres in seven seconds, to the high-risk handoffs of patients from surgery to recovery and intensive care.
The key lessons physicians, nurses and other health professionals can get from these well-honed teams is how to use briefings and checklists to prevent errors, apply technology to transfer key information and learn afterward by mining data, according to a recent study published in the British medical journal Quality and Safety in Health Care.
"In Formula One, they have checklists, databases, and they have well-defined processes for doing things, and we don't really have any of those things in health care," said Ken Catchpole, PhD, study lead author and senior postdoctoral scientist in the Quality, Reliability, Safety and Teamwork Unit at the Nuffield Department of Surgical Sciences at the University of Oxford in England.
Catchpole has helped physicians at London's Great Ormond Street Hospital for Children use F1 techniques to improve their handoff of pediatric heart surgery patients to intensive care, with results first published in May 2007. New protocols developed in response to video examination of pit stops and visits with F1 racing crews helped cut the duration of patient handoffs and reduced omissions of critical information and technical errors by 67 per cent, the study showed.
In the US the University of California’s pediatric intensive care unit in San Francisco and the Children’s Hospital in Boston have implemented the Great Ormond Street model.
"If you watch a Formula One team change tires, you'll see there's precision and absolute clarity about what people are doing," said Dr. Peter Laussen, chief of the division of cardiovascular care at Children's Hospital Boston, which adopted the pit crew approach two years ago.
Hospitals are mainly focusing on the use of briefings and checklists in order to prevent errors, and the use of technology to transfer important information and to analyse data later. But besides technical accuracy and precision, there are other important lessons that hospitals can take away from Formula One pit crews. For example, there is the way that the driver is constantly aware of the situation around him. He knows what members of the pit crew are supposed to do, and when they are done. The driver never pulls away before he is completely sure that everyone has finished their task. Getting everyone in an operating room or an intensive care unit to be on the same page in this exact same manner is what hospitals are aiming at.
Researchers have noted the importance of the role of the lollipop man, the one who waves the car in and coordinates the pit stop. Under the new handover process, the anaesthetist is given overall responsibility for coordinating the team until it is transferred to the intensive care specialist at the termination of the handover. These same two individuals are charged with the responsibility of periodically stepping back to look at the big picture and to make safety checks of the handover.
Later this month the Risky Business conference will be held in London. This annual conference is sponsored by Great Ormond Street Hospital for Children NHS Trust, the Children's Hospital Boston, the Cincinnati Children's Medical Center, the National Patient Safety Agency (United Kingdom), the Clinical Human Factors Group, the NHS Institute for Innovation and Improvement and the British Medical Journal. The overarching aim of the conferences is to think outside the box and share new ideas about managing risk and human factors from other high-risk industries.
This year the Risky Business themes are organised to explain why mistakes are made and how they can be mitigated, lessons from defining moments and how to approach things after they have gone wrong in terms of transparency and reconciliation, the role of whistleblowers and tighter regulations, the importance of outstanding leadership and teamwork, and how to change systems through improvement and transformation.
Speakers will look not just at what can be learned from Formula One, but also from the emergency helicopter teams and the final checks that are conducted prior to launch of the space shuttle.
The message from this work is as simple as it is powerful: ideas that are routine in one industry can be revolutionary when they migrate to another industry, especially when those ideas challenge the prevailing assumptions and conventional wisdom.
Ken Catchpole et al. Patient handovers within the hospital: translating knowledge from motor racing to healthcare. Qual Saf Health Care 2010; 19:318-322. Available at http://qshc.bmj.com/content/19/4/318.abstract
Published: 01 Nov 2010