Procedural certification in healthcare – time to get real

It goes without saying that a basic principle in a high risk industry like healthcare is ensuring all staff are properly trained to perform their tasks, and demonstrate regularly that they can maintain their skills.  It should be a given.

But surprisingly, it’s not.

At first glance, you might find this hard to believe.

But think about this from a patient’s perspective.  Healthcare regularly fails to :

  • Ensure staff are formally and visibly certified to perform hazardous procedures. Result?  The person performing your central line fails to put you in a head down position (because they were never told to) and you have a cardiac arrest from an air embolus
  • Orientate us to our workplace. Result?  The emergency response team can’t find you when you have your cardiac arrest
  • Refresh critical skills regularly. Result?  The team leader of your arrest team (having finally found you) can’t accurately recall the resuscitation algorithm (it’s been 12 months after all since he last did this), resulting in sub-optimal care, worsening your chances of survival.
  • Certify their staff to use high-stakes equipment. Result?  The arrest team, having never seen this type of defibrillator before, can’t work out how to use the pacing function required to save you
  • Monitor the frequency their staff perform uncommon, but critical, tasks. Result?  Blissful ignorance of skills degradation until it’s too late.
  • Embed policies in practice. Result?  The staff member who needs to activate the Massive Transfusion Policy has no idea how to do so, and can’t find out how before you bleed to death.

Of course, none of that actually happens in healthcare, does it?

Well, not that you’ve noticed anyway, but the statistics paint a different picture.

Some estimates have ranked healthcare error as the third highest cause of death behind only heart disease and cancer.  While many argue the merits of the statistical analyses behind these studies, any way you cut it, a huge number of people are suffering potentially preventable errors.  And let’s face it, one is too many, especially if it’s you.  Or your daughter.  Or your wife.

More than 15% of the healthcare budget of an average hospital is spent managing unintended consequences of care (complications).  In the US, this amounts to over a trillion dollars annually.  A TRILLION dollars.  That would pay for universal healthcare instantaneously.

This is not about apportioning blame to individuals.  Rather, it’s about the system failing to protect them, by exposing them to situations where they have been inadequately trained and supervised.  We can, and must, do better.

So how much more evidence do we need before we finally do what we should have been doing from the start?  Formalising a credentialing and certification process that requires us to train in a standardised way, be formally endorsed, monitor our performance and refresh our skills regularly.  A system that is recognised throughout the healthcare industry as a validated portfolio of your scope of practice.

We expect it, no, demand it, from other industries in whom we place our faith to look after our own well being (aviation, nuclear power, electrical safety to name but a few).  So why is it that we don’t hold ourselves to the same standard?

It’s time to get real.

About the author

Todd Fraser is an intensivist and retrieval physician, and the co-founder of Osler Clinical Competency Platform.

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