Avoid, Trap, and Mitigate: Development of an Evidence-Based Crisis Management Framework in Surgery

Area of Science:

• Healthcare Management
• Surgical Safety
• Aviation Safety

Background:

• Surgeons increasingly manage emergencies, necessitating tailored crisis systems.
• Cross-industry research, particularly with aviation, can improve surgical crisis control.
• Commercial aviation's safety innovations offer a model for surgical practice.

Purpose of the Study:

• To identify and adapt a surgical crisis management framework from commercial aviation.
• To operationalize this framework for practical application in surgical settings.

Main Methods:

• A multimethod qualitative study involving aviation and healthcare safety experts.
• Observational fieldwork in commercial aviation and semi-structured interviews with pilots.
• Focus groups and expert consensus to adapt the aviation model to clinical practice.

Main Results:

• Aviation crisis management model: avoid, trap, mitigate, adapted to surgical preparedness, recovery, and containment.
• Identified 7 implementation tools and 9 crisis management skills for surgical practice.
• Derived from 2,698 quotes from aviation experts with 188,000 hours of experience.

Conclusions:

• Surgical crisis management can adopt the aviation 'avoid, trap, mitigate' framework.
• Effective implementation requires integrating crisis skills and performance tools.
• A systems-based approach with failure management models and simulation is recommended.