O C T O B E R 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 9
they see something wrong.
Who should lead the time out? Our policy didn't specify. It should be the sur-
geon, the one with the scalpel in his hand, but in most cases the circulator led
the time out. Back then, the reason was simple: The nurse was my employee,
and I knew she'd ensure that we took a proper time out. Some physicians
viewed the time out as a nuisance and a time-waster. "This is my patient," they'd
fume. "You're just holding me up. I know what he's here for and I know what
I'm doing!" Well, not always.
I've been a director of surgical services for 17 years and I've seen a cultural
change among surgeons. They now realize the importance of marking the site and
of doing the time out all together without any distraction.
About the other wrong-site cases
Fortunately, our other 2 wrong-site surgeries were also more instructive than
destructive. You don't often hear about a general surgeon who operates internal-
ly working on the wrong site, but that's what happened with a patient who was
scheduled for an umbilical hernia and a left inguinal hernia. The surgeon
marked the umbilical (midline) and he marked the left side of the abdomen. We
then prepped and draped the patient. Of course, when you drape for laparo-
scopic surgery, you drape the entire abdomen, not just the left or the right side.
The surgeon went in laparoscopically and found a hernia on the right and a mid-
line hernia. The error was discovered in the recovery room, when the nurse
asked for the procedure and the post-op diagnoses. "Whoa," she told the sur-
geon. "We were supposed to do the left, not the right." The surgeon went in and
operated on the left hernia as well. The patient ended up having 3 hernia reduc-
tions, but that was not the plan. Even though it was a happy accident that the
surgeon happened to discover a hernia on the right, this was considered a
wrong-site surgery. The lesson: Make sure the site marking remains visible after
you've draped the patient.
