He's making a list, checking it twice

Not Santa Claus... Your surgeon!

The World Health Organization is beta-testing a Surgical Safety Checklist as part of their "Safe Surgery Saves Lives" initiative. You can see the elements of the checklist here.

It's purpose is to improve communication between OR team members and avoid preventable errors during surgery.

Saskatoon Health Region's (SHR) already has a policy that a similar, somewhat shorter, checklist will be reviewed immediately before each procedure in the operating room. Our checklist is read out by the OR nurse and includes:

Confirmation of the patient's name

Confirmation of the surgery planned (including which side of the body is to be operated on)

Review of any patient allergies

Asking the surgeon whether perioperative antibiotics are required

Make sense to do this? No-brainer, right? I'll bet if you've never worked in an operating room, you just presumed that some kind of "pre-flight check" was standard procedure.

Well, it is now, but it's only recently adopted. And not wholeheartedly accepted.

Surgeons are a very conservative bunch. And we tend not to like ideas that come from outside our community. Especially if the new ideas are perceived as being extra work for not much gain. SHR's preop checklist policy certainly fell into that category, at least initially. (I admit to being an early skeptic.)

Probably the best judges of how this policy is accepted by surgeons are OR nurses. In a completely arbitrary and invalid survey of OR nurses (read: gossip in the lounge), I found that surgeons' attitudes to the preop checklist varied widely. Some surgeons accept the policy and actively participate in the procedure. Many ignore the checklist as it's being read out. (One colleague commented to me that "it's a nursing procedure, not for surgeons.")

A few surgeons actively deride the checklists. I overheard a surgeon who mocked the nurse reading the checklist, saying "C'mon, I know you have to do this, but do you really think it makes any difference? Like I don't know what procedure I'm going to do on this patient?"

Well, doctor, check out the comments in these recent blog posts regarding wrong-side surgery and preop checklists in general:

Suture for a living (The final paragraph says it all: Most important is for everyone involved to be engaged in the process...)

More than Medicine (Think how much effort/anguish could have been saved by creating a system to prevent these mistakes.)

And, if you're still not convinced, watch Tom Shillue's standup comedy bit about wrong-side surgery.



He makes it sound ridiculous. Because it is ridiculous.

Every member of the OR team should be actively involved in the preop checklist process. Maybe we should include one other person: the patient. I don't mean that the patient should listen and confirm the checklist in the OR - that would be impossible if they are sedated or asleep.

Instead, patients (families, caregivers, etc.) could be made aware that this is SHR's policy. They can be informed of this as part of their preop orientation. They may choose to confirm with their surgeon that he/she will make sure that the policy is followed during their surgery.

The surgeon may then choose one of these responses:

Yes, certainly. I believe this is an important part of the system we have put in place to ensure your safety while you are in our care.

What a load of crap! Do you really think that reading out some bureaucratic garbage is safer than my years of surgical experience? Either you trust me or you don't!

Now that should be a no-brainer.