Video Transcript: The Two Challenge Rule

Oren Guttman, MD, Co-Director of the Anesthesia Patient Safety Simulation Team at University of Texas Southwestern Medical Center

The two challenge rule comes out of the army aviation manual, and it basically says effectively that one crew member who sees an unsafe action by another calls them out the first time, and if there’s no response, he calls him out a second time on the action. If there’s no response after two challenges that crew member is empowered to take over the critical duties of that person, in order to safe the airplane, and we’ve embodied that in healthcare. In order to have a safety net when we see things that are critical to patient safety, whether it’s life or limb, to empower anyone in the healthcare system to put a hard stop on anything that they think will cause permanent or temporary harm to a patient. We call that a nuclear option because you can’t really go around and overthrow the normal hierarchy of care, unless you really do think that this is going to cause harm to a patient. And for that reason when we deal with two challenge, we really need hospital systems to embed in their policies and procedures protection for people to make those things said and bring those issues up to utilize this tool effectively. Otherwise, it is less likely to be utilized and implemented for fear of retribution.