메뉴 건너뛰기




Volumn 89, Issue 1, 2011, Pages 4-38

Counterheroism, common knowledge, and ergonomics: Concepts from aviation that could improve patient safety

Author keywords

costs and cost analysis; health knowledge attitudes practice; human engineering; Medical error; safety management

Indexed keywords

ALCOHOL CONSUMPTION; ARTICLE; AVIATION; CHECKLIST; CONCEPTUAL FRAMEWORK; CONTINUING EDUCATION; COST BENEFIT ANALYSIS; ELECTRONIC PRESCRIBING; ERGONOMICS; ERROR; HEALTH CARE; HEALTH CARE SYSTEM; HEALTH EDUCATION; HOSPITAL MANAGEMENT; INTERPERSONAL COMMUNICATION; MEDICAL ERROR; MEDICAL STAFF; MONITOR; NURSING STAFF; PATIENT INFORMATION; PATIENT SAFETY; PRIORITY JOURNAL; RECORDING; SAFETY; STANDARDIZATION; TEAMWORK; TRAFFIC SAFETY; WORK SCHEDULE;

EID: 79953063589     PISSN: 0887378X     EISSN: 14680009     Source Type: Journal    
DOI: 10.1111/j.1468-0009.2011.00623.x     Document Type: Article
Times cited : (42)

References (64)
  • 1
    • 79953060844 scopus 로고
    • Air Accidents Investigation Branch. Report on the Accident to Boeing 737-400, G-OBME, Near Kegworth, Leicestershire, on 8 January 1989. Report 4/1990. Available at (accessed December 15, 2010)
    • Air Accidents Investigation Branch. 1990. Report on the Accident to Boeing 737-400, G-OBME, Near Kegworth, Leicestershire, on 8 January 1989. Report 4/1990. Available at (accessed December 15, 2010).
    • (1990)
  • 2
    • 17844392604 scopus 로고    scopus 로고
    • Five system barriers to achieving ultrasafe health care
    • Alamberti, Y.A., D. Berwick, and, P. Barach,. 2005. Five System Barriers to Achieving Ultrasafe Health Care. Annals of Internal Medicine 142: 756-64. (Pubitemid 40593778)
    • (2005) Annals of Internal Medicine , vol.142 , Issue.9 , pp. 756-764
    • Amalberti, R.1    Auroy, Y.2    Berwick, D.3    Barach, P.4
  • 3
    • 33847641934 scopus 로고    scopus 로고
    • Association of Anaesthetists of Great Britain and Ireland. Available at (accessed December 15, 2010)
    • Association of Anaesthetists of Great Britain and Ireland. 2004. Checklist for Anaesthetic Equipment. Available at (accessed December 15, 2010).
    • (2004) Checklist for Anaesthetic Equipment
  • 4
    • 0035975409 scopus 로고    scopus 로고
    • Mortality among Patients Admitted to Hospitals on Weekends as Compared with Weekdays
    • Bell, C.M., and, D.A. Redelmeier,. 2001. Mortality among Patients Admitted to Hospitals on Weekends as Compared with Weekdays. New England Journal of Medicine 345 (9): 663-68.
    • (2001) New England Journal of Medicine , vol.345 , Issue.9 , pp. 663-668
    • Bell, C.M.1    Redelmeier, D.A.2
  • 6
    • 85013689545 scopus 로고    scopus 로고
    • PACE: Probe, Alert, Challenge, and Emergency Action
    • Besco, R.O., 1999. PACE: Probe, Alert, Challenge, and Emergency Action. Business and Commercial Aviation 84 (6): 72-74.
    • (1999) Business and Commercial Aviation , vol.84 , Issue.6 , pp. 72-74
    • Besco, R.O.1
  • 7
    • 0142243423 scopus 로고    scopus 로고
    • Bed occupancy and overcrowding as determinant factors in the incidence of MRSA infections within general ward settings
    • DOI 10.1016/S0195-6701(03)00153-1, PII S0195670103001531
    • Borg, M.A., 2003. Bed Occupancy and Overcrowding as Determinant Factors in the Incidence of MRSA Infections within General Ward Settings. Journal of Hospital Infection 54 (4): 316-18. (Pubitemid 37554929)
    • (2003) Journal of Hospital Infection , vol.54 , Issue.4 , pp. 316-318
    • Borg, M.A.1
  • 9
    • 79953048547 scopus 로고    scopus 로고
    • CDC (Centers for Disease Control and Prevention). Available at (accessed December 15, 2010)
    • CDC (Centers for Disease Control and Prevention). 2008. Hand Hygiene Saves Lives: Patient Admission Video. Available at (accessed December 15, 2010).
    • (2008) Hand Hygiene Saves Lives: Patient Admission Video
  • 11
    • 0023103661 scopus 로고
    • Some effects of alcohol and simulated altitude on complex performance scores and breathalyzer readings
    • Collins, W.E., H.W. Mertens, and, E.A. Higgins,. 1987. Some Effects of Alcohol and Simulated Altitude on Complex Performance Scores and Breathalyzer Readings. Aviation, Space, and Environmental Medicine 58 (4): 328-32. (Pubitemid 17048017)
    • (1987) Aviation Space and Environmental Medicine , vol.58 , Issue.4 , pp. 328-332
    • Collins, W.E.1    Mertens, H.W.2    Higgins, E.A.3
  • 15
    • 79953054263 scopus 로고    scopus 로고
    • EASA (European Aviation Safety Agency) Sections AMC OR.OPS.030.FC and OR.OPS.130.FC. Available at (accessed January 7, 2011)
    • EASA (European Aviation Safety Agency). 2009. Notice of Proposed Amendment No. 200902C, Sections AMC OR.OPS.030.FC and OR.OPS.130.FC. Available at (accessed January 7, 2011).
    • (2009) Notice of Proposed Amendment No. 200902C
  • 16
    • 0003987250 scopus 로고
    • FAA (Federal Aviation Administration) Title 14, Part 121, Section 121.542; and Part 135, Section 135.100. Available at (accessed December 15, 2010)
    • FAA (Federal Aviation Administration). 1981. Code of Federal Regulations, Title 14, Part 121, Section 121.542; and Part 135, Section 135.100. Available at (accessed December 15, 2010).
    • (1981) Code of Federal Regulations
  • 17
    • 79953046582 scopus 로고    scopus 로고
    • FAA (Federal Aviation Administration). Available at (accessed December 15, 2010)
    • FAA (Federal Aviation Administration). 2002. Security Risk Management Guide. Available at (accessed December 15, 2010).
    • (2002) Security Risk Management Guide
  • 18
    • 0003577283 scopus 로고    scopus 로고
    • FAA (Federal Aviation Administration)., Title 14, Part 91, Section 91.17. Available at (accessed December 15, 2010)
    • FAA (Federal Aviation Administration). 2006. Code of Federal Regulations, Title 14, Part 91, Section 91.17. Available at (accessed December 15, 2010).
    • (2006) Code of Federal Regulations
  • 19
    • 38449085341 scopus 로고    scopus 로고
    • The Checklist: If Something so Simple Can Transform Intensive Care, What Else Can It Do
    • December 10. Available at (accessed December 15, 2010)
    • Gawande, A., 2007. The Checklist: If Something So Simple Can Transform Intensive Care, What Else Can It Do New Yorker, December 10. Available at (accessed December 15, 2010).
    • (2007) New Yorker
    • Gawande, A.1
  • 21
    • 84888461458 scopus 로고    scopus 로고
    • Human as Hero
    • Godlee, F., 2009. Human as Hero. BMJ 338: b238.
    • (2009) BMJ , vol.338
    • Godlee, F.1
  • 22
    • 0036904946 scopus 로고    scopus 로고
    • Human factors engineering and patient safety
    • Gosbee, J., 2002. Human Factors Engineering and Patient Safety. Quality and Safety in Health Care 11: 352-54. (Pubitemid 35463392)
    • (2002) Quality and Safety in Health Care , vol.11 , Issue.4 , pp. 352-354
    • Gosbee, J.1
  • 23
    • 76349119445 scopus 로고    scopus 로고
    • A Surgical Safety Checklist for Australia and New Zealand
    • Gough, I., 2010. A Surgical Safety Checklist for Australia and New Zealand. ANZ Journal of Surgery 80 (1/2): 3-5.
    • (2010) ANZ Journal of Surgery , vol.80 , Issue.12 , pp. 3-5
    • Gough, I.1
  • 24
    • 42549150483 scopus 로고    scopus 로고
    • Medical Error Death Risk 1 in 300
    • November 7. Available at (accessed December 15, 2010)
    • Hall, S., 2006. Medical Error Death Risk 1 in 300. The Guardian, November 7. Available at (accessed December 15, 2010).
    • (2006) The Guardian
    • Hall, S.1
  • 26
    • 34247139223 scopus 로고    scopus 로고
    • Quantifying distraction and interruption in urological surgery
    • DOI 10.1136/qshc.2006.019711
    • Healey, A.N., C.P. Primus, and, M. Koutantji,. 2007. Quantifying Distraction and Interruption in Urological Surgery. Quality and Safety in Health Care 16: 135-39. (Pubitemid 46596453)
    • (2007) Quality and Safety in Health Care , vol.16 , Issue.2 , pp. 135-139
    • Healey, A.N.1    Primus, C.P.2    Koutantji, M.3
  • 28
    • 0040602907 scopus 로고    scopus 로고
    • Standardization of Flight Decks-Operational Aspects
    • ed. H. Soekkha,. Ridderkerk: Ridderprint
    • Lande, K., 1997. Standardization of Flight Decks-Operational Aspects. In Aviation Safety, ed., H. Soekkha, 189-201. Ridderkerk: Ridderprint.
    • (1997) Aviation Safety , pp. 189-201
    • Lande, K.1
  • 29
    • 79953056492 scopus 로고    scopus 로고
    • Lauda Air. Available at (accessed December 15, 2010)
    • Lauda Air. 1999. Training Manual for Boeing 767 Crews. Available at (accessed December 15, 2010).
    • (1999) Training Manual for Boeing 767 Crews
  • 30
    • 79953067176 scopus 로고    scopus 로고
    • Cockpit Chatter Cited in Six Crashes
    • October 1. Available at (accessed December 15, 2010)
    • Levin, A., 2009. Cockpit Chatter Cited in Six Crashes. USA Today, October 1. Available at (accessed December 15, 2010).
    • (2009) USA Today
    • Levin, A.1
  • 34
    • 70349859842 scopus 로고    scopus 로고
    • Applying Quality Improvement Approaches to Health Care
    • Marshall, M., 2009. Applying Quality Improvement Approaches to Health Care. BMJ 339: b3411.
    • (2009) BMJ , vol.339
    • Marshall, M.1
  • 37
    • 79953054459 scopus 로고    scopus 로고
    • NASA (National Aeronautics and Space Administration). Available at (accessed December 15, 2010)
    • NASA (National Aeronautics and Space Administration). 2009. Patient Safety Reporting System. Available at (accessed December 15, 2010).
    • (2009) Patient Safety Reporting System
  • 38
    • 33845490103 scopus 로고    scopus 로고
    • Medical Team Training-An Overview
    • Available at (accessed December 15, 2010)
    • Neily, J., E. Dunn, and, P.D. Mills,. 2004. Medical Team Training-An Overview. Topics in Patient Safety 4 (5): 1-3. Available at (accessed December 15, 2010).
    • (2004) Topics in Patient Safety , vol.4 , Issue.5 , pp. 1-3
    • Neily, J.1    Dunn, E.2    Mills, P.D.3
  • 41
    • 23644461837 scopus 로고    scopus 로고
    • NPSA (National Patient Safety Agency). Available at (accessed December 15, 2010)
    • NPSA (National Patient Safety Agency). 2004. Seven Steps to Patient Safety: The Full Reference Guide. Available at (accessed December 15, 2010).
    • (2004) Seven Steps to Patient Safety: The Full Reference Guide
  • 42
    • 79953057302 scopus 로고    scopus 로고
    • NPSA (National Patient Safety Agency). Available at (accessed December 15, 2010)
    • NPSA (National Patient Safety Agency). 2009a. Alerts. Available at (accessed December 15, 2010).
    • (2009) Alerts
  • 43
    • 34247541477 scopus 로고    scopus 로고
    • NPSA (National Patient Safety Agency). Available at (accessed December 15, 2010)
    • NPSA (National Patient Safety Agency). 2009b. National Reporting and Learning System. Available at (accessed December 15, 2010).
    • (2009) National Reporting and Learning System
  • 44
    • 79953051618 scopus 로고    scopus 로고
    • NPSA (National Patient Safety Agency). Available at (accessed December 15, 2010)
    • NPSA (National Patient Safety Agency). 2010. Safer Surgery Checklist for Cataract Surgery Only. Available at (accessed December 15, 2010).
    • (2010) Safer Surgery Checklist for Cataract Surgery only
  • 45
    • 79953051829 scopus 로고    scopus 로고
    • NTSB (National Transportation Safety Board). In Aircraft Accident Report NTSB/AAR-06/01 (chapter 1.18.2). Available at (accessed December 15, 2010)
    • NTSB (National Transportation Safety Board). 2006. Additional Flight Crew-Related Accident Information. In Aircraft Accident Report NTSB/AAR-06/01 (chapter 1.18.2). Available at (accessed December 15, 2010).
    • (2006) Additional Flight Crew-Related Accident Information
  • 46
    • 0347645290 scopus 로고    scopus 로고
    • Social Networks, Communicative Acts and the Multilingual Individual: Methodological Issues in the Field of Language Change
    • ed. E.H. Jahr, Berlin,. Germany: Mouton de Gruyter
    • Oksaar, E., 1998. Social Networks, Communicative Acts and the Multilingual Individual: Methodological Issues in the Field of Language Change. In Language Change: Advances in Historical Sociolinguistics, ed., E.H. Jahr, Berlin, 3-20. Germany: Mouton de Gruyter.
    • (1998) Language Change: Advances in Historical Sociolinguistics , pp. 3-20
    • Oksaar, E.1
  • 47
    • 0037979236 scopus 로고    scopus 로고
    • Applying Airline Safety Practices to Medication Administration
    • Pape, T.M., 2003. Applying Airline Safety Practices to Medication Administration. Medical-Surgical Nursing 12: 77-93.
    • (2003) Medical-Surgical Nursing , vol.12 , pp. 77-93
    • Pape, T.M.1
  • 48
    • 73349108830 scopus 로고    scopus 로고
    • Complex Working Environment, Not Poor Training, Blamed for Drug Errors
    • Pownall, M., 2009. Complex Working Environment, Not Poor Training, Blamed for Drug Errors. BMJ 339: b5328.
    • (2009) BMJ , vol.339
    • Pownall, M.1
  • 50
    • 0034681819 scopus 로고    scopus 로고
    • Human error: Models and management
    • Reason, J., 2000. Human Error: Models and Management. BMJ 320 (7237): 768-70. (Pubitemid 30179429)
    • (2000) British Medical Journal , vol.320 , Issue.7237 , pp. 768-770
    • Reason, J.1
  • 53
    • 79953044691 scopus 로고    scopus 로고
    • Adopting a Surgical Safety Checklist Could Save Money and Improve the Quality of Care in U.S. Hospitals
    • Semel, M.E., S. Resch, A.B. Haynes, L.M. Funk, A. Bader, W.R. Berry, T.G. Weiser, and, A.A. Gawande,. 2010. Adopting a Surgical Safety Checklist Could Save Money and Improve the Quality of Care in U.S. Hospitals. Health Affairs 29 (9): 1593-99.
    • (2010) Health Affairs , vol.29 , Issue.9 , pp. 1593-1599
    • Semel, M.E.1    Resch, S.2    Haynes, A.B.3    Funk, L.M.4    Bader, A.5    Berry, W.R.6    Weiser, T.G.7    Gawande, A.A.8
  • 54
    • 79953048926 scopus 로고    scopus 로고
    • Flight Recorder: The Witness Box
    • September 22. Available at (accessed December 15, 2010)
    • Sims, J., 2010. Flight Recorder: The Witness Box. The Independent, September 22. Available at (accessed December 15, 2010).
    • (2010) The Independent
    • Sims, J.1
  • 55
    • 84888453414 scopus 로고
    • Evaluatie Onderzoek VVN-Campagne Alcohol in Het Verkeer 1986-1991. VK 91-10. Haren: Traffic Research Centre, University of Groningen. Quoted in European Transport Safety Council. 1995
    • Brussels. Available at (accessed December 15, 2010)
    • Söder, J.C.M., 1991. Evaluatie Onderzoek VVN-Campagne Alcohol in Het Verkeer 1986-1991. VK 91-10. Haren: Traffic Research Centre, University of Groningen. Quoted in European Transport Safety Council. 1995. Reducing Traffic Injuries Resulting from Alcohol Impairment. Brussels. Available at (accessed December 15, 2010).
    • (1991) Reducing Traffic Injuries Resulting from Alcohol Impairment
    • Söder, J.C.M.1
  • 56
    • 74949131873 scopus 로고    scopus 로고
    • Practical Challenges of Introducing WHO Surgical Checklist: UK Pilot Experience
    • Vats, A., C.A. Vincent, K. Nagpal, R.W. Davies, A. Darzi, and, K. Moorthy,. 2010. Practical Challenges of Introducing WHO Surgical Checklist: UK Pilot Experience. BMJ 340: b5433.
    • (2010) BMJ , vol.340
    • Vats, A.1    Vincent, C.A.2    Nagpal, K.3    Davies, R.W.4    Darzi, A.5    Moorthy, K.6
  • 57
    • 34248375662 scopus 로고    scopus 로고
    • A Culture of Safety or Coping? Ritualistic Behaviours in the Operating Theatre
    • Waring, J., S. Harrison, and, R. McDonald,. 2007. A Culture of Safety or Coping? Ritualistic Behaviours in the Operating Theatre. Journal of Health Services Research and Policy 12 (supp. 1): 3-9.
    • (2007) Journal of Health Services Research and Policy , vol.12 , Issue.SUPPL. 1 , pp. 3-9
    • Waring, J.1    Harrison, S.2    McDonald, R.3
  • 58
    • 66149124706 scopus 로고    scopus 로고
    • WHO (World Health Organization). 1st ed. Available at (accessed December 15, 2010)
    • WHO (World Health Organization). 2008a. Implementation Manual Surgical Safety Checklist. 1st ed. Available at (accessed December 15, 2010).
    • (2008) Implementation Manual Surgical Safety Checklist
  • 59
    • 70349213732 scopus 로고    scopus 로고
    • WHO (World Health Organization). 1st ed. Available at (accessed December 15, 2010)
    • WHO (World Health Organization). 2008b. Surgical Safety Checklist. 1st ed. Available at (accessed December 15, 2010).
    • (2008) Surgical Safety Checklist
  • 60
    • 79953052709 scopus 로고    scopus 로고
    • WHO (World Health Organization). Available at (accessed December 15, 2010)
    • WHO (World Health Organization). 2008c. The WHO Surgical Safety Checklist: Adaptation Guide. Available at (accessed December 15, 2010).
    • (2008) The WHO Surgical Safety Checklist: Adaptation Guide
  • 62
    • 84855636681 scopus 로고    scopus 로고
    • David Warren: Inventor and Developer of the "black Box" Flight Data Recorder
    • July 31. Available at (accessed December 15, 2010)
    • Williamson, M., 2010. David Warren: Inventor and Developer of the "Black Box" Flight Data Recorder. The Independent, July 31. Available at (accessed December 15, 2010).
    • (2010) The Independent
    • Williamson, M.1
  • 63
    • 84937563307 scopus 로고    scopus 로고
    • Essential Characteristics of Resilience
    • ed. E. Hollnagel, D.D. Woods, and N. Leveson,. Farnham: Ashgate
    • Woods, D.D., 2006. Essential Characteristics of Resilience. In Resilience Engineering: Concepts and Precepts, ed., E. Hollnagel, D.D. Woods, and, N. Leveson, 21-34. Farnham: Ashgate.
    • (2006) Resilience Engineering: Concepts and Precepts , pp. 21-34
    • Woods, D.D.1
  • 64
    • 0023001176 scopus 로고
    • Hangover effects on aircraft pilots 14 hours after alcohol ingestion: A preliminary report
    • Yesavage, J.A., and, V.O. Leirer,. 1986. Hangover Effects on Aircraft Pilots 14 Hours after Alcohol Ingestion: A Preliminary Report. American Journal of Psychiatry 143: 1546-50. (Pubitemid 17196197)
    • (1986) American Journal of Psychiatry , vol.143 , Issue.12 , pp. 1546-1550
    • Yesavage, J.A.1    Leirer, V.O.2


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.