A communication ontology for improving quality and safety management in air medical transport

Air medical transport (AMT) is a complex process that requires coordination of aircraft and highly skilled professionals to transport critically ill patients to definitive care. To achieve optimal performance, medical transport services employ quality and safety management systems (QSMS) to report errors and evaluate performance. Unfortunately, there are no standards for classifying miscommunication in these systems. A thoughtfully developed ontology, based upon theoretical models, provides the foundation within a QSMS for reporting communication errors and standardizing analysis. This research used a mixed-methods, pre-post design, with four distinct studies to analyze communication at the Life Flight AMT service. Study 1 was a qualitative study of communication and miscommunication. Study 2 (pre) was a quantitative study measuring communication errors in reports to the QSMS. Study 3 developed a new communication ontology for the QSMS to improve reporting and analysis of communication errors. Study 4 (post) implemented the new ontology and evaluated its performance for analyzing communication errors in the QSMS. Study 1 showed that communication in this AMT service is a complex process that may require more than 28 communication interactions between 10 or more people and utilize as many as 6 different communication technologies. Omissions of information were the most frequent communication errors described. Study 2 revealed that Life Flight's ontology in their QSMS was inadequate for measuring communication errors. iii Two hundred seventy-eight event reports were reviewed from the QSMS with 58 (21%) having evidence of a communication error during transport. Of those 58 reports, only 18 (31%) could be retrieved by a simple query. A new, theory-based, communication ontology was developed in Study 3. Study 4 showed the new communication ontology more than doubled the ability to retrieve reports with communication errors by simple query of the QSMS (71%). Furthermore, analysis showed that 50% of communication errors occurred at the initial phase of transport. The most frequent errors were information not being forwarded to key persons (37%). This research provided the foundation for describing and measuring communication errors in an AMT Service. Further research is needed to identify strategies that will improve information distribution between persons involved with patient transport.