Quality Assurance Beyond the Hospital Walls

Implementing auditing, outcome tracking, and continuous improvement in an aviation-based care model

By Phebe McKay

Let’s be honest — healthcare quality shouldn’t stop at the hospital doors.

When patients are in the air, they’re still under our care. And just because the environment changes — from a hospital room to a jet cabin — doesn’t mean our standards should. If anything, they need to be tighter.

I’ve spent years in aviation-based care. I’ve seen what works and what doesn’t when it comes to delivering safe, high-quality service in an environment with no backup, no hallway consults, and no room for error. What I’ve learned is this: The best teams treat every transport like it’s a mobile ICU, with the same level of accountability you’d expect in any brick-and-mortar facility.

So how do we make that real?

1. Audit Like It Matters — Because It Does

In hospitals, we audit everything: hand hygiene, medication safety, documentation. But in aviation-based care, audits often get treated as a formality — or worse, skipped entirely due to time constraints.

That’s a mistake.

Post-transport audits need to be more than check-the-box exercises. They should capture:

• Clinical decision-making under pressure

• Adherence to protocols despite environmental constraints

  
  
  
  

• Communication patterns with the sending/receiving teams

  
  
  
  

• Equipment performance and any failure points

Done right, audits don’t just protect your organization — they teach. They offer a chance to spot patterns, uncover training needs, and tighten processes before problems escalate.

2. Track Outcomes — Even When It’s Hard

Measuring outcomes in transport is tricky. We don’t own the whole episode of care. But that doesn’t mean we’re off the hook.

We can track things like:

• Pre- and post-transport vitals

  
  
  
  

• Response to interventions en route

  
  
  
  

• Unplanned events (e.g., hypotension, airway issues)

  
  
  
  

• Readmissions related to transport complications

And we should be talking to partner hospitals to follow up on patient outcomes. It’s not always easy to get that data — but building those relationships pays off. It helps us improve, build credibility, and speak with confidence about our impact.

3. Build a Culture of Real-Time Feedback

One of the biggest shifts we made in our own program was encouraging peer review and self-reporting that’s non-punitive but action-oriented.

Here’s what that looks like:

• Short debriefs after every flight

  
  
  
  

• Open discussions about near misses

  
  
  
  

• A team-wide commitment to continuous learning

  
  
  
  

The truth is, most people want to do the right thing. But they need permission and structure to talk about what went wrong — and how to make it better.

4. Invest in Improvement, Not Just Compliance

Compliance is the floor, not the ceiling. If your program is only focused on passing inspections or checking regulatory boxes, you’re missing the point.

Instead, we aim for:

• Ongoing education tailored to real cases

  
  
  
  

• Scenario-based training for rare but critical events

  
  
  
  

• Simulation audits to test readiness, not just knowledge

You can’t improve what you don’t measure — and you can’t grow a high-performing team without systems that support honest evaluation and feedback.

Bottom line?

Aviation-based healthcare deserves the same rigor as any hospital. When we raise the bar on quality assurance — through smarter audits, better tracking, and a culture of learning — everybody wins.

Patients are safer. Teams are sharper. And the entire industry moves forward.

That’s what excellence looks like at 30,000 feet.