Heartbeat: Aviation procedures flying high in maternity theatres

August 31, 2018

You could be easily be forgiven for thinking that life inside the cockpit of an aircraft ready for take-off is a totally different ball game to the inside of a maternity theatre. However, a pilot and a surgeon are both poised to carry out important procedures – take-off is considered one of the most trickiest aspects of flying a plane, whilst a surgeon is about to take the life of a mother and an unborn baby into their hands.

Both of these situations require a sense of calm, which is why we are seeing procedures which have been in common place in the world of aviation for a long time coming into play within settings.

Heartbeat caught up with Speciality Theatre Manager, Kay Stokes and Senior Theatre Practitioner, Alan Dickens to find out how the ‘silent cockpit’ is making a difference in our maternity theatres.

The silent cockpit is an extension of the World Health Organisation surgical safety checklist, which was introduced to the NHS after commercial airline pilot, Martin Bromiley, who lost his wife during routine surgery, suggested that healthcare services could learn from the checks involved in aviation

“There is a rule in aviation which means that below 10,000 feet the pilot and co-pilot aren’t allowed to talk about anything which isn’t relevant to that flight,” explained Kay.

Alan added: “It is a rule which has been in place in aviation since 1981 after a review of some serious incidents showed that pilots had been distracted by engaging in non-essential conversations during critical parts of the flight.”

The idea to introduce the silent cockpit into our organisation came after Kay attended training which looked at how human factors play a part within healthcare.

“We decided to ‘pilot’ the idea in maternity theatres during elective surgery,” said Alan.

“An obstetric theatre can be a busy place, there are staff from different specialities involved in a caesarean section and previously there could be different pockets of conversations going on any one time.

“The patients are awake during these procedures and we know that by creating an environment in which there are no conversations, other than about that patient or procedure, we could reduce errors, but also create a better experience for the patient.”

Kay said: “We wanted to improve the patient experience; we had received a couple of comments that patients could overhear conversations whilst in theatre.”

She continued: “No mum-to-be would want to end up in theatre, but by looking at the environment we are creating in theatre, and ridding it of unnecessary noise; we can get as close to a normal birthing experience for the patient as possible.

“We encourage them to bring in a choice of music and try to create a very calm experience.”

The silent cockpit was initially trailed during May 2018 and after taking a while to embed, positive feedback from patients and their birthing partners has been plentiful and the decision was made to continue.

“It was strange to start with,” said Alan.

“As soon as the patient walks into theatre, there is no talking other than anything which is relevant to the patient or about the procedure. It has taken a while to become the norm and we still have to issue to odd reminder during a procedure, but feedback from patients and staff alike has been brilliant. Staff have seen the difference that it can make to the patient experience and agree that it creates a better, calmer and ultimately safer experience.

“Surgeons have fedback that they like it and feel that there are fewer distractions.”

Kay added: “We have also found that communication amongst the surgical team is much improved. There is no chance of miss-communication as there is no noise disruption.”

One lady recently who was on her fourth C-section at our hospital and she commented that she experience of the silent cockpit was noticeably different to her other births.

Kay said: “She told us that whilst she never had any complaints with her previous births, this one was definitely her best experience. She said the theatre was noticeably quieter and that she felt calmer and that she could clearly hear the music which she had chosen to play.”

At the moment, the silent cockpit is only in operation during elective procedures in maternity, but both Kay and Alan have a vision to roll it out across other theatres and to continue to educate staff to its importance.

“Alan has done a fantastic job of introducing it,” said Kay.

“The challenge now is to keep pushing it and driving it more. We have done a presentation to the theatre staff during our quality improvement half day and we have signs up in the theatre to remind people.”

Alan concluded: “It has been a great start and we are really looking forward to seeing what we can achieve with the silent cockpit over the next six months.”