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Study: Pre-op briefing can lower surgical errors

January 25, 2007 — 8:01pm ET
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Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

A study conducted by Johns Hopkins among its own surgeons, anesthesiologists and nurses has reached a fairly intuitive conclusion-that a brief pre-operation meeting between surgical team members can lower the number of wrong-person and wrong-site surgeries. In June 2006, Hopkins Hospital implemented a JCAHO policy requiring hospitals to have a pre-surgical conversation in the OR before each and every surgery. In their version, surgical team members hold a two-minute meeting in which all OR team members state their name and role, after which the lead surgeon verifies a patient's identity, surgical site and related safety issues. The meeting takes place before anesthesia or incision takes place.

Johns Hopkins surgeon Martin Makary, M.D., M.P.H., director of the Johns Hopkins Center for Surgical Outcomes Research, then studied the effect of implementing the policy. The study, which will appear in the February issue of the Journal of the American College of Surgeons, concluded that team meetings had a positive effect on team morale and perception of safety, if nothing else. A survey given to 147 surgeons, 59 anesthesiologists, 187 nurses and other OR staff members found that 90 percent felt that the new briefings were important and could impact on patient safety.

To get more background on the study:
- read the Johns Hopkins press release on the study results
- review the United Press International article on the study

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Comments

By Narayanachar S. Murali | Posted 3:00pm | January 27, 2007

It is an absolute no brainier. It is nice that the Hopkins Surgeons have learned to talk with their assisting staff before procedures. The JCAHO actually requires something called "Timeout". All US Hospitals have dutifully mandated this policy. Nurses and doctors don't seem to understand the real purpose of this mandate. In our hospital's endoscopy suite, often times TIMEOUT is a ritualistic utterance of "This is XYZ lying on the left side for a colonoscopy with the colonoscope by the bedside!" I have often asked them "Why would you keep a bazooka or a Telescope by the bedside if I want to look into someone's colon?" On the contrary if I were to ask the nurse what is the precise indication for the procedure, they are hopelessly lost. This is true of nurses on hospital floors as well. They are so focused on absurd protocols they do not know the list of problems of the patient. Some nurses are so scared of the senor surgeons that they fail to ask pertinent questions like "what is wrong with this patient Mr/Ms. XYZ. What are you planning to do during surgery. What am I expected to do to get things right?" Unless the doors of communication are opened wide and clearly written history pertinent to the procedure is on the chart, no surgery or procedure should take place. There is nothing routine about medical or surgical procedures. There is a risk of things growing wrong all the time. Patients contribute in no small measure to this hellish confusion. They could be hiding medical history, not telling the truth, not bringing their list of medications or just not knowing their medical and surgical history in detail. There is NO SUBSTITUTE TO A CHRONOLOGICAL HEALTH HISTORY, labs, X-ray REPORTS,PROCEDURAL PHOTOS IN A PDF FORMAT ON A USB DRIVE carried to the surgical suite.. It will save countless lives by avoiding confusion and dangerous treatments. This is the least expensive and most effective personal health record in an electronic form.

By Healthcare coordinator | Posted 1:46pm | October 31, 2007

Until physicians are no longer paid for never events they will continue to happen. In 2008 Medicare (and probably most healthcare insurance plans) will stop paying hospitals for these events, but will continue to pay the surgeons! How ridiculous is that?!
So now hospitals will be financially accountable for these errors, while the physicians (which are essentially contractors) will not be.

By Anne Zieger | Posted 9:28am | November 1, 2007

I agree -- there does seem to be a misalignment of incentives. Particularly when you consider that apparently, surgeons are typically the ones who decline to follow established safety guidelines, not staff, according other research I've published here. This doesn't look like a situation which will remain workable for very long.

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