Checklists and balances
Dr. Haynes believes tools such as the surgical safety checklist can
remove the issue of courage from the equation, so to speak.
"A checklist makes it clear that all members of the team need to
know the details of the surgery and have valuable contributions and
should give those contributions a voice," he says. "By doing that at the
beginning of an operation, it creates a culture where the amount of
courage to speak up about areas of concern or question is almost
irrelevant."
In his role as associate director of the Safe Surgery Program at
Ariadne Labs, Dr. Haynes — a longtime proponent of surgical safety
checklists — was the lead author of a recent study that measured the
effects of a voluntary surgical safety checklist on the perioperative
outcomes of patients at 14 South Carolina hospitals
(osmag.net/S6MssE). The 19-point checklist prompted members of a
hospital's surgical team to discuss the surgical plan, as well as any
risks or concerns they had, during each of the 3 phases of surgery:
before induction of anesthesia ("sign in"); before the incision ("time
out"); and before the patient leaves the operating room ("sign out"). In
each phase, a checklist coordinator confirmed that the surgical team
completed the listed tasks before proceeding.
The results: The participating hospitals decreased their 30-day post-
operative mortality rate from 3.38% in 2010 — before the program's
J U N E 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 6 9
Surgery can get there, too, but I think we need to compress the time-
frame. It shouldn't take decades for an industry to have its people
feel comfortable enough and empowered enough to raise their voice
in what could be a life-or-death situation.
The point is this: You don't have to be the one holding a scalpel to
recognize a situation that could result in tragedy. — Spence Byrum
