Improving patient safety in and around the operating theatre

Further improvement can only be made when the causes – particularly those relating to human error - are brought out into open and ways of dealing with them discussed. To prevent harm and death to patients undergoing surgical procedures, it is important to confront these taboo subjects and implement actions to reduce surgical site infection and improve teamwork and communication.

Improving the perioperative care process is a multi-faceted task given its unique and challenging environment. The operating theatre is a stressful place to work and teams need to rely on one another to uphold hygiene standards. Throughout the patient’s stay staff are under time pressure and cost pressure and this need to be taken into account when drawing up plans to improve patient safety.

Recommendations also need to take into account, among other things, complexities in clinical care, sophisticated technologies that may be excellent for their intended purpose but incapable of synchronising with other technologies, and the vast array of supplies and instruments that need to be managed by clinical teams.

Teamwork

Currently, other than a quick assessment of the facts relating to a particular procedure, perioperative clinicians and staff have little opportunity to spend time with individual surgical patients. Because of this lack of familiarity there is an increased risk of patient misidentification, miscommunication of the planned procedure, and a failure to record important information such as allergies.

Administration and organisation

Surgery involves considerable planning and coordination, which means multiple clinicians, and care teams need to work together -- not only to share patient information but also to integrate their work into a larger care process.

As well as the number of people involved, there are many types of equipment, instruments, medications, blood products, and supplies that need to be planned and prepared to be at the same time and the same place. Typically, a different department or group manages each item (e.g. central supply, sterile instrument processing, patient transport, pharmacies, blood banks, surgical pathology and other departments). The more people involved, the higher the risk of human error.

Finally, the OR staff must also integrate their work with many other departments, such as recovery units, surgical clinics, radiology, laboratory, emergency department, critical care units, and others.

Since 2008, the WHO has been promoting a “Surgical Safety Checklist” in order to improve patient safety. It was developed after extensive consultation with medical professionals. It aims to decrease errors and adverse events, and increase teamwork and communication in surgery. Despite evidence that proves it has made a significant reduction in both morbidity as well as mortality, the checklist is not used by a large number of professionals all over the world. Each country is encouraged to adapt it to its specific needs to ensure most optimal usage. (http://www.who.int/patientsafety/safesurgery/checklist/en/)

Technology

There is a growing focus on the importance of technology use within health care and proven software design approaches and standards are available. However, too often, national health care technology modernisation efforts have failed to recognise the unique requirements of perioperative care in both their vision and their priorities.

If they are focused on the specific challenges in the perioperative environment, they can be an important catalyst to transform surgical care. Health care standards need to be reviewed to ensure full support of perioperative requirements.

Products

Easy, effective products and solutions can play a vital role in increasing patient safety provided they: offer a holistic level of care, facilitate and shorten the time and effort of treatment, and are intuitive to use.

• Fostering a culture of safety in operating rooms and other perioperative settings.
• The introduction of concise briefings in which surgical team members introduce themselves by first name, discuss the procedure, ask questions and have the chance to raise issues that might come up.
• Sufficient time outs for clinicians so that they do not overwork.
• Consistent adherence to evidence-based practices and standards for preventing infection
• Committing to follow guidelines that enhance routines.
• Making performance transparent on key measures.
• Improving transitions of care from the OR to the intensive care unit through a structured handoff process that helps ensure care teams exchange vital information about the patient.
• Using simulation to help improve teamwork and communication among caregivers, and also to help them practice new procedures on mannequins.