Safer surgery: What you need to know

Hearing the news that you or someone you know needs to “go under the knife” can be troubling. When we enter the operating room, we’re putting our bodies and our trust in the hands of strangers with scalpels, medications and machines. Every surgery has its risks, and we’ve all heard horror stories about the things that can go wrong.

Even the statistics can be a little daunting. Every year, more than 234 million major surgeries are performed worldwide, according to the World Health Organization (WHO). (That’s about one surgery for every 25 people each year.) Of this number, more than 7 million patients will suffer complications and about one million will die. Overall, half of those issues could be have been prevented.

It’s not always a matter of economics, sanitary conditions and access to healthcare. Even in developed countries, surgical safety issues account for half of all “adverse events” that lead to death and disability. For instance, as many as 12,000-24,000 Canadians die each year as a result of harm that could have been prevented, according to the Canadian Patient Safety Institute (CPSI). Unfortunately, safety measures that save lives aren’t consistently and reliably used, even in industrialized countries.

The costly mistakes

It may sound like fiction, but these mistakes do happen more than we realize. According to studies, some dangerous mistakes that can occur include:

Wrong site or wrong procedure. For instance, removing the left kidney instead of the right, or operating on the wrong knee. In rare cases, the wrong patience has received surgery due to a mix-up.

Lack of briefing . Many errors in judgment can be attributed to a lack of information, like not being aware of a patient’s medical history or allergies.

Not being prepared for the risks . Experts argue that more needs to be done to prepare for life-threatening risks like loss of airway or high blood loss. Proper monitoring as well as having the right equipment and supplies on hand can make a difference.

Anaesthetic mistakes like problems with the machines, lack or monitoring or lack of trained staff. These types of mistakes are far more common in developing countries than developed ones.

Instruments or sponges left in the body .

Failure to prevent infection — like unsterile equipment and not washing hands or preparing properly.

In addition, studies have shown that poor communication among members of the surgical team can lead to mishaps. In some cases, the team has never worked together before, and some members may not feel comfortable speaking up about concerns or issues.

True, most surgeries don’t result in problems like these ones, but any number preventable errors is still too high.

The Safer Surgery Checklist

Wouldn’t it be nice if hospitals around the world had a consistent list of things to double check and discuss to help ensure patients stay safe?

That’s the goal of the Safe Surgery Saves Lives (SSSL) campaign. Starting in 2007, the WHO Patient Safety initiative made surgical safety its next challenge to address, and by 2009, it had developed and tested its Guidelines for Safe Surgery. One of the outcomes was the WHO Surgical Safety Checklist — a standardized tool to help surgical teams follow crucial safety steps proven to minimize complications.

While many hospitals were already using a “time out” procedure of their own, the goal is for everyone to use a consistent set of guidelines — and use them consistently. The WHO checklist isn’t set in stone: adaptations and additions are encouraged. In Canada, the CPSI has created and implemented it’s own version.

Here’s how it works: One member of the team — often a nurse — is in charge of the list and verbally confirms that all the essentials are taken care of. The list covers three stages: briefing (before anesthetic is administered), time out or pause (before the incision is made) and debriefing (before the patient leaves the operating room).

Some of the critical steps include:

– Confirming the patient’s identity, procedure, site and consent. The incision site has to be clearly marked and checked before the first cut is made.

– Performing safety checks of equipment and making sure all necessary supplies are on hand, such as blood and supportive devices.

– Making sure the most recent labs, x-rays and test results are on hand, as well as the patient’s medical history. Final test results are reviewed again too.

– Introducing each member of the team by name and role.

– Discussing any special procedures or concerns, including a patient’s allergies and known risk factors. Surgeons, anaesthesiologists and nurses are all part of this process.

– Accounting for any instruments and aids that were used during the procedure, such as clamps and sponges.

– Discussing any concerns or issues that came up during surgery. The team will review the procedure and discuss the next steps for recovery — including any changes that need to be made as a result of the surgery.

In addition to covering all key areas, the list also facilitates good communication among team members — another plus for patient safety.

Some of the steps may seem unnecessary or redundant, but the list helps to save lives. According to pilot projects conducted across the globe, using the checklist reduced complications by more than 30 per cent.

What patients can do

The list isn’t just for hospitals and medical staff — it’s also for patient awareness. Not only does it provide some peace of mind, it’s also a way to start a dialogue about safety issues with the people who provide out care.

So what should patients do? Here are some steps experts recommend:

Get the information you need — and check it twice. Staff needs to obtain your “informed consent” — meaning that you should be made aware of the details of the procedure and outline all the risks involved. Don’t be shy about asking questions or seeking clarification before you sign the paperwork. After all, it is your body.

Don’t rush through the paperwork. Make sure your personal information is correct, the right procedure and site are listed and that any allergies or risk factors you might have are documented.

Get to know the list. What steps could help save your life? The list is easy to access online — you can download the CPSI list here or the WHO version here. Read it, print it out and discuss it with your doctor.

Find out where it’s being used. There are a couple of ways you can see where it’s in use:

– Use the WHO’s Surgical Safety Map. The map shows the whole world at a glance, so zoom in for a closer look and “hover over” the crosses to see the hospital’s name.

– Check the WHO’s list of supporting organizations. While it may not name specific hospitals, it does include the Canadian Association of General Surgeons , the Canadian Anaesthesiologists’ Society and Canadian Medical Association.

– Ask your doctor or any member of your surgical team. Simply say you’ve read about the list and want to know if it will be used in your case.

If your hospital isn’t officially using the list, ask what procedures and checks they follow.

Request its use. Want the list to be used during your surgery? The CPSI recommends discussing it with your surgical team along with any other concerns you might have.

Cooperate. It may seem like staff are asking you the same questions over and over again — don’t worry, that’s supposed to happen. The CPSI advises to answer all questions in full and ask for clarification if there’s something you don’t understand.

Get out a marker? It may sound extreme, but some patient safety advocates in the U.S. even recommend getting out a marker and writing instructions like “this knee” directly on the skin. If you do decide to take this step, make sure there are no other marks on your body first.

Learn more about patient safety. Where can you find more information about safer surgery and other patient safety issues? Try these sources:

Canadian Patient Safety Institute: Safe Surgery Saves Lives. You can download its Patient Safety brochure here (PDF file).

The World Health Organization: Patient Safety. For more detailed information, you can download the WHO Guidelines for Safe Surgery 2009 here (PDF file).

– Health Canada has a list of Links on Patient Safety where you can connect with provincial and international organizations.

For our international readers, check out the National Patient Safety Foundation (U.S.) and National Patient Safety Association (U.K.), or look for comparable organizations in your area.

Additional sources: ABC News; BBC News; Health Canada

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