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We thank Dr Wong for his detailed description of the importance of respiratory rate (RR) and his astute reflections on the interactions between predictable human errors and the systems in which humans work. We agree that RR is prone to error because of the human element. However, what is unique to healthcare compared with aviation is not that human error exists, but that tolerance for these errors has become an accepted part of everyday practice.1 We hypothesise that RRs can be measured both accurately and efficiently, but this requires institutional culture change starting with improvements in staff education, expectations and accountability, which can be accomplished through a quality improvement (QI) initiative. We have initiated this process at our own institution.
To guide our local ongoing QI initiative, we mapped the workflows …
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