A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Anthony Ardire
Published: 10/28/2008
Preventing surgery on the wrong body part or patient is the aim of the Joint Commission's universal protocols. So why do these so-called "never events" still happen? Because the surgical timeout is sometimes seen as a speed bump on the road to surgical efficiency and not an integral part of the facility's culture of safety and communication.
The emphasis on high volume in the ambulatory setting puts no more or no less emphasis on pre-op surgical site and patient identification checks as compared to inpatient surgery. Staff and surgeons alike in both settings must make those precautions as routine as donning gloves. Preventing wrong-site or wrong-patient surgeries actually begins before the patient reaches the OR. Follow these steps for each patient that walks through the door on the day of surgery.
Watch these lapses
Those are the basics emphasized during every orientation program and annual training session. You'd think surgical misidentifications would be a thing of the past, yet regardless of how often you emphasize the importance of surgical timeouts, mistakes happen. Have your staff watch for the following wrong-site surgery risk factors.
Confronting the surgeon
At my hospital, circulating nurses complete a form to document that the surgical team completed all steps of a proper timeout. We also affix timeout stickers to instrument trays and hang timeout posters to serve as constant visual reminders of our hospital's safety policies. Each employee is implored to take ownership in the hospital's safety record. Nurses are empowered by the hospital's administration to stop a surgery if the proper precautions aren't followed.
It can be difficult for nurses or techs to confront a surgeon. While most surgeons are onboard with a facility's safety efforts, difficult personalities are a reality of life in the OR. Try this hard-and-fast rule: A challenge from any two members of the surgical team necessitates an automatic and immediate consult for a consensus on what's being done and by whom.
Expanding on the timeout
Not only does the timeout provide an opportunity to identify inconsistencies and to prevent errors in the OR, but by improving overall communication it helps empower all members of the team to continue the dialogue during the operation if things do not seem to be going according to plan. In fact, we're not only focused on ensuring the surgical timeout, but we're also looking to expand on it. In 2008, in addition to preventing wrong-site surgeries, we're aiming to have timeouts confirm that the patient received the proper antibiotic 60 minutes before surgery.
The Joint Commission requires that doctors "sign their site." Yet a study in the September 2006 issue of the journal Archives of Surgery reports that the problem may be 20 times more common than previously thought, occurring between 1,300 and 2,700 times a year and that prevention efforts may be inadequate.
Inside Pennsylvania's Wrong-site Surgery Data |
Wrong-site surgical errors occur in Pennsylvania's healthcare facilities every other day, according to an advisory from the state's Patient Safety Authority. The report claims that the authority received 174 reports of actual wrong-site surgery events and 253 notifications of near-misses between June 2004 and Dec. 2006.
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