Elsevier

Air Medical Journal

Volume 32, Issue 3, May–June 2013, Pages 129-137
Air Medical Journal

Original Research
Analyzing Communication Errors in an Air Medical Transport Service

https://doi.org/10.1016/j.amj.2012.10.019Get rights and content

Abstract

Introduction

Poor communication can result in adverse events. Presently, no standards exist for classifying and analyzing air medical communication errors. This study sought to determine the frequency and types of communication errors reported within an air medical quality and safety assurance reporting system.

Methods

Of 825 quality assurance reports submitted in 2009, 278 were randomly selected and analyzed for communication errors. Each communication error was classified and mapped to Clark's communication level hierarchy (ie, levels 1–4). Descriptive statistics were performed, and comparisons were evaluated using chi-square analysis.

Results

Sixty-four communication errors were identified in 58 reports (21% of 278). Of the 64 identified communication errors, only 18 (28%) were classified by the staff to be communication errors. Communication errors occurred most often at level 1 (n = 42/64, 66%) followed by level 4 (21/64, 33%). Level 2 and 3 communication failures were rare (, 1%).

Conclusion

Communication errors were found in a fifth of quality and safety assurance reports. The reporting staff identified less than a third of these errors. Nearly all communication errors (99%) occurred at either the lowest level of communication (level 1, 66%) or the highest level (level 4, 33%). An air medical communication ontology is necessary to improve the recognition and analysis of communication errors.

Introduction

Air medical transport (AMT) is a complex process that requires the coordination of aircraft and highly skilled professionals to transport critically ill or injured patients to definitive care. Failure to communicate effectively can result in poor coordination, increased errors, and adverse events. Research has shown poor communication to be a significant factor in adverse events in aviation,1, 2 health care,3, 4 and AMT.5 To prevent adverse events or mitigate their impact, organizations use quality and safety management systems for reporting issues, reviewing events, and reducing risks. Although poor communication is recognized as a key factor in adverse events, there are no standard frameworks or ontologies for quality and safety management systems to classify and analyze communication issues. Therefore, it is difficult to provide effective indicators for quality improvement. As a result, organizations develop custom reporting systems that often lack sufficient detail or usefulness for analyzing communication errors.

This study had 3 purposes: to determine the frequency of AMT communication errors reported within an AMT quality and safety management system, to analyze how staff classified communication errors, and to analyze communication errors using Clark's framework of communication.

Section snippets

Study Site

The setting for this study is an AMT service that provides adult, pediatric, and neonatal transport services. Patient transport is provided by rotor wing, fixed wing, ground ambulance, or any combination. This transport service averages approximately 11 patient transfers per day, with roughly half being pediatric/neonatal and half being adult. The majority of transports are interfacility transfers rather than scene flights.

Study Period

The study period was January 1, 2009, to December 31, 2009.

Theoretic Framework of Communication

The theoretic

Research Question 1: How Often Are Communication Errors Evident in Quality and Safety Assurance Reports?

Of the 278 reports reviewed, 58 had evidence of a communication error (21%). Table 6 provides the distribution of reports with communication errors by service and mode, whereas Table 7 provides the distribution of reports reviewed by service and mode.

Chi-square analysis showed no statistically significant differences between services (P = .810) or mode of transport (P = .328) when comparing the proportion of communication errors versus the proportion of reports submitted. Communication errors

Discussion

Miscommunication can lead to disastrous events in AMT. The accident report by the National Transportation and Safety Board of the mid-air collision of 2 medical transport helicopters in Flagstaff, AZ, on June 29, 2008, found that poor communication was a causal factor.13 The key objectives of this study were to analyze quality assurance reports to determine the frequency, types, and distribution pattern of communication errors within a theoretic framework.

At Life Flight, pilots, medical crew,

Conclusion

Current quality and safety assurance reporting systems may fail to identify key sources of communication errors because the reporting structure lacks sensitivity and specificity around these issues. The most frequent analysis asked of safety management systems is “How many and of what type?” Our results show that querying our quality and safety assurance reporting system for communication-related triggers would likely miss most communication errors. Although sensitivity could be increased by

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