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    How surgical time-outs may (or may not) lower litigation risk

    Adherence to WHO Surgical Safety Checklist can help reduce risk of error


    Three opportunities to reduce error risk

    The Surgical Safety Checklist provided by the World Health Organization, and endorsed by the American College of Surgeons, defines three clear opportunities for the surgical team to communicate and reduce the risk for error: before the induction of anesthesia, before the skin incision, and before the patient leaves the operating room (bit.ly/WHOchecklist). In any case where the urologist is not the attending, but called in to consult, for example, to examine the ureters for suspected perforation in a gynecologic case, the three steps required by the Joint Commission should be repeated.

    With regard to the WHO Surgical Safety Checklist, a 2015 study reported that in 40% of cases, the required team members were absent at the time-out and over 70% of team members failed to pause and perform safety checks (Patient Saf Surg 2015; 9:26). “Performing a time-out and implementing a checklist in the OR does not mean the patient is safe,” the authors of a 2015 Patient Safety in Surgery review article wrote (Patient Saf Surg 2015; 9:26).

    Read: Patient sues after stapler misfire leads to rectal tear

    Each team member from start to finish is responsible for safe patient care and protocols associated with their particular role. To further promote surgical safety, surgical teams embodying purpose, goals, leadership, communication, cohesion, and mutual respect can minimize errors (Patient Saf Surg 2015; 9:26). Contrarily, ineffective team communication in the operating room has been described as a “major root cause of errors” (Patient Saf Surg 2015; 9:26).

    The take-home: As the surgeon, surgical technique and skill are clearly of great importance, but even with a technically perfect surgery, errors can occur. A time-out may, but cannot be guaranteed, to identify errors or mistakes that have been made preoperatively by others involved in the patient’s care and treatment. The patient’s safety during surgery is the responsibility of many: office staff, schedulers, nursing, central processing personnel, and clinical providers in the OR, to name a few. The time-out is as strong as the weakest link in the chain. Strengthening the chain as a whole promotes patient safety and reduces the risk of an adverse outcome and the potential for litigation.

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    Brianne Goodwin, JD, RN
    Ms. Goodwin is manager of clinical risk and patient safety at Cambridge Health Alliance, Cambridge, MA.


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