All surgical procedures have varying degrees of risk and just about all individuals who are scheduled for surgery are fearful that something might go wrong. Most have heard of a sponge being left in the abdomen or other human error. However, a new study has uncovered another major source of a surgical misadventure: technology problems. Researchers affiliated with the Imperial College of London, UK reported their findings online on July 25 in the journal BMJ Quality & Safety.
The study authors note that surgical technology has led to significant improvements in patient outcomes; however, failures in equipment and technology are implicated in surgical errors and adverse events. Therefore, they conducted a study to determine the proportion and characteristics of equipment-related error in the operating room to further improve quality of care. They conducted a systematic review of the published literature and found 19,362 search results relating to errors and adverse events occurring in the operating room. They narrowed the search results down to 124 quantitative error studies (studies that quantified the errors). From those studies, they ultimately selected the 28 studies that they deemed to be the most appropriate.
The investigators found that the average number of total errors per procedure in independently-observed prospective (forward-looking) studies were 15.5. Failures of equipment/technology accounted for an average 23.5% of total error. The average number of equipment problems per procedure was 0.9. Eight studies subdivided the types of equipment failures: equipment availability (37.3%), configuration and settings (43.4%); and direct malfunctioning (33.5%). Observed error rates varied widely with study design and with type of operation. Understandably, procedures with a greater burden of technology/equipment tended to show higher equipment-related error rates. The researchers found that the use of checklists (or similar interventions) reduced equipment error by an average of 48.6% (and 60.7% in three studies using specific equipment checklists).
The authors concluded that equipment-related failures form a substantial proportion of all error occurring in the operating room. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. They found a clear benefit from the use of preoperative checklist-based systems. They proposed the adoption of an equipment check, which may be incorporated into the current World Health Organization checklist.
The WHO notes that surgical care has been an essential component of healthcare worldwide for more than a century. As the incidences of traumatic injuries, cancers, and cardiovascular disease continue to rise, the impact of surgical intervention on public health systems will grow. Therefore, the WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focused on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care. The World Alliance for Patient Safety initiated work on the Challenge in January 2007.
The focus of the Challenge is the WHO Safe Surgery Checklist. The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia (“sign in”), before the incision of the skin (“time out”) and before the patient leaves the operating room (“sign out”). In each phase, a checklist coordinator must confirm that the surgery team has completed the listed tasks before it proceeds with the operation. The manual provides suggestions for implementing the checklist, understanding that different practice settings will adapt it to their own circumstances. The implementation manual is designed to help ensure that surgical teams are able to implement the checklist consistently. By following a few critical steps, healthcare professionals can minimize the most common and avoidable risks endangering the lives and well-being of surgical patients. The Safe Surgery Saves Lives initiative is also working to promote surgical improvement programs and collaboration by building a network of users.
Take home message:
The chance of a surgical misadventure is less if you select a well-trained surgeon affiliated with a hospital with excellent credentials. Fortunately, Angelenos have access to one of the best medical facilities in the nation: Ronal Reagan UCLA Medical Center.