tunity to clear the air and get on the same page for safer patient care.
Surgeons now receive more input from staff in a more productive and
collaborative OR environment.
The small group discussions also helped level the leadership hierar-
chy in the OR, which led to one of the most important aspects of our
new culture of safety. Surgeons still take the lead in running rooms,
but their voices aren't the only ones that are heard. Nurses, techs and
anesthesia providers are empowered to speak up when they believe a
patient could be harmed. I'm concerned, they say, and everyone in the
room knows to immediately stop what they're doing to address the
issue. It's not an empty phrase; leadership provides immediate, on-the-
spot backup if a surgeon refuses to pause for safety. Nurses tell me
they're now far less hesitant to speak up to protect patients.
Our renewed effort to improve patient safety also includes these
important steps:
• Time-out audits. I'm sure your surgical team pauses before proce-
dures to identify the patient and surgical site and review important
safety factors, but are they engaged in performing complete and inclu-
sive time outs? Get out from behind your desk to find out. I perform
30 audits a month in GI procedure rooms and other clinical leaders do
the same in the ORs to ensure we're taking time outs and we're per-
forming them correctly, and that everyone in the room is actively
involved in the process.
• Documented safety checks. We created a pre-op readiness check-
list that the pre-op nurse, anesthesia provider and circulating nurse
complete and sign. The form requires the group to ensure that the sur-
gical consent is accurate, H&Ps are on hand, surgical sites are marked
and marked correctly, and infection prevention protocols have been
enacted. We also created a perioperative safety guide that the OR cir-
Safety
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