One of my new vacation passions is scuba diving. I got certified last summer and look forward to diving every chance I get. Today, I am actually writing this post from the boat in the picture since our departure has been delayed. The reason for the delay is one of the crew members was in a minor car accident this morning and we can't leave without the right number of dive-masters to guide us tourists. You might be asking yourself how this relates to healthcare, and I will attempt to connect the dots...
Diving is an amazing experience, but it can be very dangerous if certain safety precautions are not adhered to strictly. After all, as one fellow diver said to me, when diving you are entering a different world let alone one where you are not on top of the food chain! Yet everyday, flocks of
people gear up and descend into the oceans abyss and then re-emerge safely from their journey. The reason is that certain rules must be adhered to because your life may well depend on it. Equipment is carefully set-up, checked, and then re-checked by a buddy before entering the water. Before the dive begins the dive-master commands everyone's attention (i.e. takes a
"time-out") to discuss the dive site characteristics, maximum depths, bottom-time air supply, and navigational landmarks to ensure everyone can find their way back to the boat. Safety is paramount to any successful dive and it is not taken for granted. The same is true with air travel,
everyone from the pilot and crew to passengers have a pre-flight briefing and plan.
The question to me is why healthcare is resistant to doing something that is so routine with any other risky activity? For years we have preached of the importance of conducting a "time-out" before performing any invasive surgery or procedure. The Joint Commission now mandates it as part of its accreditation standards. The part that boggles me is why we don't
consistently do it with everyone's full attention? Do our surgeon's and staff think they are incapable of doing wrong? Just because someone is proficient in doing something, doesn't mean that they are immune to life's accidents that are waiting to happen to the inattentive or unprepared. I have been driving for years, but I still look in the rear-view mirror
before I put the car in gear and back out of my parking space.
If I've struck a nerve with anyone, I'm glad! I've hopefully made my point to someone who probably is not adhering to our guidelines. To make my point more clear, just as I was leaving for this trip I was informed of an incident that occurred in one of our procedural areas as a result of not performing a correct time-out. No permanent harm was done to the patient, but an unnecessary procedure was performed as a result of this physician and team not performing a thorough time-out. All were fortunate in the outcome (most thankfully our patient), but it wouldn't take much for you to imagine a situation in which the outcome could have been much different.
It is time for this to stop! We all have the right and responsibility to prevent harm from happening to our patients, and it has to start at the bedside. Physician champions like Dr. Mike Bousamra, Chief of the Department of Surgery have personally taken on this cause. For several
months, Dr. Bousamra has been piloting a surgical briefing with the entire surgical crew immediately before and after the case. Everyone identifies themselves by first name (including the surgeon) and describes their role in the case. A checklist of information is discussed and then the procedure begins. This is a practice that has been endorsed by the World Health Organization (WHO) and has been proven to reduce mortality rates by up to a third in the hospitals that have adopted its use (See article in New England Journal of Medicine). We will be exploring how to take Dr. Bousamra's good work and instill that practice throughout the hospital.
I will end for now, but expect to revisit this topic soon. To those that are not up to speed on our best practices, consider yourself advised - as always I welcome any comments you may have on how to guarantee compliance in this area. To the rest I hope I've reaffirmed your commitment to the well being and safety of the patients that entrust their lives with us. Thank you for the good work you are doing!
3 comments:
As someone who has preached "time out" for over 5 years.... THANK YOU! I have met with resistance from CSTs, RNs and MDs and it has been frustrating. Why does doing the right thing have to be mandated before the process is taken seriously? I have heard every excuse in the book why they (team members and surgeons) "can't do it the right way". We have to be the patient's advocate and protect that patient who has entrusted us with their care. All of us have to make the conscious effort to put patient safety FIRST and foremost.
Thank you for the vote of support! Just curious, as someone who has "preached" time-outs...what do you see as the reason people don't comply? How do we get people to willingly do the right thing in your opinion?
There are many systems causes of surgical errors. They include distractions, time constraints, surgeon pressure, scheduling discrepancies and adjustments, data entry errors and missing documentation. Many patient handoffs are necessary, as well. There are countless things going on, all of which are competing for the staff person’s attention.
In my opinion, the steps of Universal for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery (correct patient, procedure, site verification - and site marking and timeout) are not enough on their own. The participants need to take an authentic and mindful approach in order to facilitate the elements of the protocol. Mindfulness is a process that allows a person to be fully present, alert and engaged. It is active versus passive. The pathways to the senses are open to allow the person to be steady in their attention. You have to choose to be mindful, especially in a busy pre-op area and OR. I think we need to evolve to a point where mindfulness is cool. I think if surgeons and the rest of the surgical team choose to insert group mindfulness into their process and see the alternative as little more than a warehouse gig where “time is money” we will be successful in maximizing the protection of our patients. As a team approach to work life in the OR takes hold, we may even see an increase in job satisfaction as an aside! Now THAT'S cool!
Kathy Fitzgerald, RN, BSN
Patient Safety Officer, JHMC
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