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they can tell someone."
Physicians are key
Not that the total commitment — and the expenditures that would be
required — were an easy sell. "A lot of people felt it was too time-con-
suming and that all these steps were unnecessary," says Ms. Fairchild.
Once the board made the final decision to go all in, everything started
with the surgeons. "We made sure we had the physicians on board
before we started training the staff," says Ms. Fairchild. "And we all
know they're 100% committed to the effort, which is important because
it makes the staff more committed."
Once patients reach the OR, surgeons lead the facility's time outs,
but that's not until numerous other safety-ensuring protocols have
been strictly followed.
"It all starts before the patient even walks in the door to the center,"
says Ms. Fairchild. "The procedure is verified by the scheduler and we
use a universal protocol form that starts in pre-op and focuses on patient
identification, procedure verification and site marking. If sites are
unmarkable, we use an armband, which must be applied by the surgeon.
The rationale is that surgeons mark sites, so if an alternate method is
used, they need to apply the alternate method, too."
The process also includes making sure all needed implants and
antibiotics are available, and checking patient ID. "Everything is docu-
mented and it's a very, very rigid procedure," says Ms. Fairchild. "It
creates at least 3 hard stops, where someone's going, hold on, stop the
boat, do I have everything I need?"
If anything is missing — if a patient needs to have an H&P updated,
if a consent still needs to be signed, or if a pre-op nurse has any con-
cerns — a color-coded flag is affixed to the chart. No flagged charts
are permitted through the OR door, and flags can only be removed by
