Improving Patient Safety: Lessons from Other Disciplines

Quality of clinical laboratory services means more than providing analytically accurate test information. The goal is to improve patient outcomes without imposing harm.1,2 Quality improvement in laboratory services requires focusing on both analytical excellence and patient-centered aspects of care. Technology in the clinical laboratory is complex and changes rapidly, factors which may increase the opportunity for errors to occur. Intentional system design and analysis can help reduce errors and mitigate the effects of those that occur.3 Many industries have made quality and safety improvement a priority for their services and products. Laboratorians can learn from other industries' experiences, selecting approaches likely to result in improved quality and safety of laboratory services. Aviation Industry One model for improving healthcare is the safety improvement experience of the aviation industry. Although the characteristics and consequences of error in aviation are different than those in medicine (i.e., few highly visible incidents, each involving many lives, versus many individual incidents which may not be reported or even acknowledged), the two fields have common attributes. Both involve complex technology and highly trained specialists who share some aspects of professional culture.4 Certain principles of error management, as practiced by aviation, may be applicable to medical laboratory science. A necessary starting point for quality improvement in any system is the collection and evaluation of information regarding the frequency and nature of incidents. Most errors that occur in a professional setting are classified as “blameless” and indicate the need to modify systems, as opposed to disciplining individuals. To understand… ABBREVIATIONS: AHRQ, Agency for Research and Quality; CAP, College of American Pathologists, CPOE, computerized provider order entry; CRM, crew resource management; FAA, Federal Aviation Administration; FDA, Food and Drug Administration; HAI, healthcare associated infections; LOSA, line operations safety audit; NTSP, National Transportation Safety Board; PSO, Patient Safety Organization; SRE, serious reportable event