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Taking a cue from industries like aviation, physicians and care teams can use proven tools to keep patients from harm.

Fam Pract Manag. 2023;30(2):24-28

This content conforms to AAFP criteria for CME.

Author disclosure: no relevant financial relationships.

communication tools

Next time you fly, pay attention to the flight crew's language. You might hear something like “Flight attendants, set doors to arrival, cross-check, and all call,” or “Ladies and gentlemen, we will be arriving at gate B-nine. That's Bravo-nine.” This is more than just industry jargon. It's a way to communicate quickly and clearly, in order to reduce errors.

According to the World Health Organization, people have about a one-in-300 chance of being harmed during health care (versus one-in-a-million traveling by plane).1 Examples of patient harm include dispensing the wrong medication, failing to recognize symptoms, or amputating the wrong limb. While the risks in outpatient medicine do not usually rise to the level of hospital care, there is still the potential for bad outcomes (e.g., prescribing an antibiotic that your patient is allergic to). In fact, it's been estimated that 6% of hospital stays are the direct result of an error in the ambulatory setting.2


  • While errors are often more serious in hospital care, they can compromise patient safety in outpatient settings as well (e.g., prescribing an antibiotic your patient is allergic to).

  • Clear communication between members of the health care team is critical to avoiding errors, and tools such as SBAR and BLUF can help.

  • Situation awareness, cross-checking, and clinical huddles can help members of the care team work synergistically to prevent harmful errors.

Highly reliable organizations, in health care or other industries, have systems in place to prevent errors and often obsessively focus on error reduction (see “The five principles of high-reliability organizations”). The first step in implementing such systems in your practice is to develop a culture of safety and accountability in which physicians and teams talk openly about mistakes and identify ways to prevent them, a concept that has been addressed before in this journal.3 Once you've established that culture, this article can help you expand on it with specific team-based tools to improve safety.


1. Preoccupation with failure.

2. Reluctance to simplify interpretations.

3. Sensitivity to operations.

4. Commitment to resilience.

5. Deference to expertise.

Source: Weick KE, Sutcliffe KM. Managing the Unexpected – Assuring High Performance in an Age of Complexity. Jossey-Bass; 2007.

Some errors can be prevented through technology and automation (e.g., an EHR that notifies physicians if they've prescribed something on the patient's allergy list). But preventing other errors requires the health care team to work together. Think of the following strategies like Swiss cheese: If we layer in enough safety interventions (i.e., cheese slices), then the holes in the cheese will be less likely to line up and allow errors to slip through (see “Swiss cheese safety model”).

For example, if I ask my medical assistant (MA), “Can you give the patient in Room 5 a tetanus vaccine?” there are several potential “holes.” It's a verbal order, so the MA may not have heard me clearly and understood what I meant. When I said “tet-anus,” did I mean Tdap, Td, or DTaP? What if I really meant that I wanted Mrs. Jones in Room 4 to have a pneumonia vaccine, but I misspoke because I was thinking about Mr. Smith in Room 5 who asked me when his last tetanus shot was. Any one of these holes could cause an error, but if we “Swiss cheese” the visit by layering in enough of the following tools, we can greatly reduce the odds.

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