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observed 2 surgeons in 2 hospitals follow that time out, a few minutes
later, with "Have we done the time out yet?"
The key is constructing the time out so that people have no choice but
to be engaged. Providers are taught to ask patients questions that require
active rather than passive responses. For example, you don't ask, "Are
you Mrs. Jones?" you ask, "What is your name?" Similarly, in the OR, the
circulating nurse (or whoever's running the time-out) should be saying,
"Doctor, would you give me the name of the patient? The procedure we're
doing?" and so on.
The Pennsylvania Patient Safety Authority's wrong-site surgery initiative
recommends that your business office staff note the side and the site of the
procedure when scheduling the case. This information should be re-verified
by pre-admission staff. These kinds of changes might take a little effort. You
might have to revise forms, paper or electronic. Or devise a script that
engages surgeons. But it's not too much to ask — get the appropriate people
together over pizza to hash out what's sensible for conveying information.
There are outliers that can't be prevented from inside the OR. For example, a mix-up in a pathology department that leads to the wrong surgical
procedure for the wrong patient. But such instances should be extremely
exceptional cases. I'd estimate that, at the least, we could eliminate 249 of
every 250 that occur, although zero is the true goal. It's a number everyone understands, and we shouldn't make excuses for more than that. OSM
Dr. Clarke (jclarke@ecri.org) is the editor of the Pennsylvania Patient Safety
Advisory, clinical director of the Pennsylvania Patient Safety Authority and a professor of surgery at Drexel
University in Philadelphia.
ON THE WEB:
Pennsylvania Patient Safety Authority
• 21 Recommendations and Barriers to Preventing
Wrong-Site Surgery http://bit.ly/UGH9DT
• Wrong-Site Surgery Toolkit http://bit.ly/nTXLxH
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