A study of Johns Hopkins surgeons, anesthesiologists
and nurses suggests that hospital policies requiring a
brief pre-operation "team meeting" to make sure surgery is
performed on the right patient and the right part of the
body could decrease errors.
In the study, which will appear in the February issue
of the Journal of the American College of Surgeons,
Johns Hopkins operating room personnel were "very positive"
about the briefings, according to surgeon Martin Makary,
director of the Johns Hopkins Center for Surgical Outcomes
Research and lead author of the study.
"Although we lack systems for uniform reporting of
wrong-site surgeries to understand the extent of the
problem, we observed team meetings increase the awareness
of OR personnel with regard to the site and procedure and
their perceptions of operating room safety," Makary said.
He stressed that wrong-site surgery is exceptionally rare
but entirely preventable.
A study published last year in the Archives of Surgery
that looked at 2.8 million operations in Massachusetts over
a 20-year period suggests that the rate of "wrong-site"
surgery anywhere other than the spine is one in every
112,994 operations. The study excluded the spine because
researchers defined wrong-site surgeries as operations
conducted on a different organ or body part than intended
by the surgeon and patient, and the spine is one body part.
So, even though a surgeon may have operated on the wrong
area, technically he or she operated on the right part of
the body.
The Joint Commission, which evaluates and accredits
nearly 15,000 health care organizations and programs in the
United States, requires hospitals to have a pre-surgical
conversation in the OR before every surgery.
Although no national standard for the OR conversation
was set by the commission, Makary and others led efforts at
Johns Hopkins to enforce the mandate, developing a
standardized briefing program that became policy at The
Johns Hopkins Hospital in June 2006. Since then, he has
collaborated with Rochester, Yale, Columbia and Cornell
universities and the World Health Organization to broaden
the use and reach of the Johns Hopkins program.
During the two-minute briefing, all members of the OR
team state their name and role, and the lead surgeon
identifies and verifies such critical components of the
operation as the patient's identity, the surgical site and
other patient safety concerns. The briefing is performed
after anesthesia is administered and prior to incision.
For this study, a survey of 147 surgeons, 59
anesthesiologists, 187 nurses and 29 other OR staff was
given twice — before the policy was implemented and
after it had been in effect for three months.
After training, a 13.2 percent increase in those who
believed the policy would be effective was recorded. And
more than 90 percent of those surveyed agreed with the
statement that "a team discussion before a surgical
procedure is important for patient safety."
"The Joint Commission identified communication
breakdowns as the most common root cause of wrong-site
surgeries," Makary said. "Our research indicates that OR
personnel see pre-surgical briefings as a useful tool to
help prevent such errors."
Before the new policy was implemented, Makary noted,
many surgeons would walk into the operating room and start
working without a conversation of any kind and without even
knowing the names of the nurses and other staff who were
assisting them.
The survey is based on a similar questionnaire
designed by the airline industry to assess programs
designed to reduce safety errors.
Johns Hopkins faculty members Peter J. Pronovost and
Bryan Sexton also contributed to the article.
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