1. USING THE AERONAUTICAL MODEL TO DECREASE MEDICAL ERROR IN FAMILY MEDICINE RESIDENTS
A Pilot Study
Stephen Stripe MD, FAAFP
Shirley Cole-Harding PhD
Vicki Michels PhD

2. The Problem
IOM in 1999 showed that 44,000 to 98,000 people die/year due to medical error.
$17 to $29 Billion dollars are spent due to medical error per year. Not including the legal fees.
An article in the Journal of Medical Practice Management 2004 stated that as much as $97.5 Billion in hospital and physician service costs per year is due to malpractice litigation.

3. Aeronautical Model
85% of all accidents and 52% of all general aviation accidents are due to pilot error, i.e. poor decision making or risk management.
FAA instituted 12 years of research.
Most errors were cognitive in nature; the result of attitudes, behavioral traps, stresses and other influences.
Since 1987 pilots have been teaching risk management techniques.

4. Aeronautical Model
10-50% decrease in accident rate since the introduction of the curriculum to pilots.
The largest general aviation insurance company in the U.S. has seen a 50% decline in claims of those pilots who have taken the course versus those who have not.

5. Medicine
A recent study (Stripe et al., 2006) showed that up to 59% of the same type of factors identified in aviation accidents can be identified in medical malpractice cases that go to trial in a legal data base.

6. Method - Participants
Family Medicine Residents; PGY1, 2, and 3 from FM program were enrolled.
The last 4 months of the academic year.
Paid $5/day that they reported errors.
14/15 residents entered study.
8/14 completed the entire study period reporting every day.

7. Method - Procedure
Self reporting errors on a form placed in a lock box that the primary investigator could not access. Each resident had a code name. The errors reports were collected twice a week by personnel not directly involved with the residents.
A certificate of confidentiality was obtained.
Type of errors were reported; procedural, orders, assessment, prescription, miscommunication, other and none.
They also reported the following items: illness, medication, stress, psychoactive subst., fatigue, hunger/thirst, need to relieve oneself, strong emotion and other.
Reported errors for one month.
Had two sessions of training during a two week period.
Reported errors for one month following.

8. Results Decrease in errors: Procedural- 16.67% Orders- 26.99%
Assessment %
Prescription %
Miscommunication %
Other %
Average %
No errors %
None Significant

9. Results Effect sizes ES = Mean difference/SD
These are low (.2) to medium (.5) effect sizes according to Cohen’s rule of thumb.
The medium effect sizes (near .5) indicate that further results would probably be significant with a larger sample size.
Procedures
Orders
Assessment
Prescription
Mis-communication
Other

10. Medicine Factors Percent decrease I- Illness; 15.33%
M- Medication %
S- Stress %
A- Alcohol or other psychoactive subst. 100%
F- Fysiologic
Fatigue %
Hunger %
Need to relieve
Oneself %
E- Emotion %
Average Percent Decrease %

11. Medicine Problems Not statistically significant Small sample size
No control group.
Didn’t separate out differences between PGY.
Change over time.
Self Reporting

12. Proposal Get grant for a larger study
Effect sizes indicate this is a potentially significant project
Need 200 subjects for a statistical significant number of 100 considering 50% drop out rate.
Control group would receive training at the end.
Two experimental groups with cross over.

13. Conclusion
This is not meant to replace the systems approach. Both cognitive and systems is needed.
40.2% decrease in error translates into possibly 17,688 to 39,396 lives saved per year and $6.8 to $11.7 Billion saved per year.