Could doctors use a copilot?

By Chelsea Conaboy, Globe Staff

Patient safety experts have been calling on doctors to act more like pilots -- to acknowledge that their job is complex and that simple checklists can help them do it better. Harvard researcher and Brigham and Women’s Hospital surgeon Atul Gawande has played a major role in popularizing the idea with his book, The Checklist Manifesto.

Checklists are central to airplane safety, and pilots are taught from day one to be disciplined in using them. Now researchers at Northwestern University Feinberg School of Medicine in Chicago have suggested that doctors adopt something else from the cockpit: a copilot.

The researchers compared two intensive care units at Northwestern Memorial Hospital, each with a distinct staffing team. Both teams used checklists on patient rounds. But one team was accompanied by a “prompter,” a resident whose sole purpose was to use a script to remind the team about specific issues. The resident, for example, would note how many days a patient had been on antibiotics for a suspected infection and ask whether the treatment should be continued, encouraging discussion among the team members.

Patients cared for by the team with a prompter spent fewer days on those antibiotics, the researchers found. They also spent less time on ventilators or with a central venous catheter inserted, they had lower mortality, and they spent less time in the ICU on average.

The process allowed team members to hold each other accountable and increased adherence to the checklist even on days when the prompter was not present, lead author Dr. Curtis Weiss said.

“It did lead to a cultural change, a decisionmaking change,” he said.

Having a second set of eyes on a checklist makes a big difference. So says my dad. He has been a pilot for 41 years, flying jets internationally and single-engine Cessnas for fun, on wheels and on floats. For him, the use of checklists is ingrained.

When he’s flying with another pilot, one calls out an item on the checklist and the other verifies it. When he is flying a small plane with a new student or by himself, he goes through the same call and response process with himself -- always out loud. But he knows one set of eyes can miss what two would catch.

Preparing for a solo flight in a seaplane recently, he ran through the checklist as he always does before take off, noting, among many other things, the position of the flaps on the wings. He started to skate across the lake’s surface but the plane would not lift off the water. He realized that while he had noted that the flaps were in the proper position for takeoff they weren’t.

No harm done. But, it’s an example of a time where a copilot could have helped even a highly-trained professional using the right tools to do a job better.

Weiss said he and others are looking at how to apply the process they used at Northwestern in other areas of the hospital and at other institutions. The prompter role could be filled by a professional other than a physician or possibly by an electronic script, he said.

Of course, Weiss said, the practice requires buy-in from doctors and others on the team and a recognition that the process is not about challenging doctor authority but about working together for better patient care.