Safety and risk management : from aviation to medicine.

Feasibility study of implementing a safety management system in emergency medicine.

"Airlines and hospitals need two things to survive: financial strength and public trust. A robust safety culture bolsters both." This is the opening sentence of a recent book (Patankar, Brown, Sabin et Bigda-Peyton , Safety Culture, 2012) which connects risk management approach adopted by the aviation for decades to the needs of the medical world. Several human error prevention patterns, either by training or by standardized procedures or checklists, are already applied, especially in the Anglo-Saxon world, and especially in technical specialties, such as anesthesia or surgery (eg, the " Safe Surgery Saves Lives " program of WHO).

Despite the fact that such an approach is meaningful in emergency medicine (time pressure, team work, need of complex and multifactorial decision making), and the fact that "Human Factors" are in head of the ALS manual according to the latest ERC 2010 guidelines, there is to date no research on the implementation of security management essential components in emergency medicine, as defined by ICAO (International Civil Aviation Organisation), namely:

- A systematic analysis of the activity processes, including the risks assessment and the formulation of prevention and mitigation strategies.

- An information system on the security breaches (accidents, incidents or mishaps).

- A group of experts able to analyze information and provide practical prevention recommendations.

- The definition of safety performance indicators, with the aim of a quantified monitoring.

- An awareness of all stakeholders, from operators to managers, to create a real cultural change.

The purpose of this project is to develop a plan for the implementation of such a strategy in emergency medicine, both in the intra- and extrahospital activities. This will include two hereinbefore components, firstly the activity processes analysis and the risk assessment, and secondly the definition of performance indicators with a quantified monitoring.

This project is conducted within two Brussels Hospitals : the Centre Hospitalier Molière-Longchamps, with Professor Roger Hallemans, and the Centre Hospitalier Universitaire Brugmann, with Dr Patrick Guérisse and Dr Olivier Vermylen. This study is funded by the Iris Research Funds, King Baudouin Foundation.