sitting around in the doctor's lounge waiting for the room to be
cleaned or for the next patient to be prepped.
"If I have the ideal length surgery — which for me is just under an
hour — and if I have the proper staff with me, whether it's a physician
assistant, resident or fellow who can put in the final stitches, then I
can be doing another surgery in another room and all that down time
gets washed away," says W. Hodges Davis, MD, of OrthoCarolina.
Dr. Davis sees every patient personally in the recovery room. Before
he walks into the next room, though, he goes to the pre-op area and
talks to the on-deck patients. He reminds them of the procedure that
is to be done and goes over the consent and marks the site. And he
goes through the same procedure with each patient every time.
In addition, once in the OR, with the patient asleep and before he
makes the incision, he stops again to take a time out to go over the
consent with the team and confirm the procedure.
"That's where there can be problems, if you don't pause and go over
the consent again," says Dr. Davis.
He then confirms the correct side and pauses again and either he or
the circulating nurse will repeat the consent once more. At that point,
the anesthesiologist confirms that it is the right patient, that it is the cor-
rect limb and the type of anesthetic.
Dr. Davis admits there are times when he goes to talk with a
patient's family and then heads for the next case without having had
the pre-op conversation with the next patient or signed the site. That's
when the staff becomes the next safeguard. They stop the process
until he goes back and completes all the steps. It takes buy-in from
the staff to know that the doctor is not going to get angry at them for
delaying him and it takes buy-in from the surgeon to know that if he
misses a step and if he doesn't participate in those key times, then
patients could get hurt.
4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 8
