Several times a month, anesthesiologist Keith Ruskin, M.D., flies to Block Island or Martha’s Vineyard for lunch. Each time he climbs into the pilot’s seat, he plans the flight as meticulously as if it were his first time in the cockpit.
“Prior planning prevents poor performance—that’s an aviation mantra,” said Dr. Ruskin, director of neurosurgical anesthesia for Yale Medical Group and holder of a commercial pilot certificate. It’s the same touchstone he uses to prepare himself and his colleagues each time they enter the operating room.
Dr. Ruskin brings several aviation safety techniques into the operating room, including critical event checklists and flow checks, in which personnel methodically evaluate every item needed for a procedure in preparation for the task in front of them, whether it’s the switches and gauges in a cockpit, or the equipment on an anesthesia workstation. Even though an anesthesiologist usually meets a patient only once, Dr. Ruskin said, “I look at the members of the anesthesia team as the ultimate patient advocates; we take care of people when they truly cannot take care of themselves, keeping the heart beating, the blood flowing, and the breathing steady.”
Dr. Ruskin has long been interested in how clinical decisions are made, and how errors can be avoided. He is an internationally recognized expert on operating room safety; author of numerous publications on anesthesia informatics, neurosurgical anesthesia, and medical information technology; and a Federal Aviation Administration-designated aviation medical examiner.
“We want to know what is happening when someone who has the right information and training nonetheless makes an error,” he said. “That way we can predict what problems could occur, and learn to manage situations before they become problems.”
One of the lessons that Dr. Ruskin has learned as he trains to become a flight instructor is that, contrary to popular belief, good judgment and effective decision-making are skills that can be taught. He is teaching those skills to an increasing number of medical professionals. The culture of medicine is beginning to shift, putting greater openness to examining vulnerabilities in systems, and to discussing how clinicians can adjust practices to achieve the highest possible level of patient care, he said.
“The fact that humans can fly is pretty amazing, but no more so than what we do every day in the operating room,” Dr. Ruskin said. Neither should ever be treated as routine.”