All 12 hospitals and 21 surgery centers in Rhode Island have agreed to adopt uniform procedures to prevent wrong-site surgery and other errors.
With an emphasis on clear communication among surgeons, staff and patients, the protocol is designed to prevent errors but also to avoid the confusion that can sometimes occur when practitioners split their time between facilities with different policies. It's "important, especially in a small state where many physicians work in several hospitals, to have a policy which is consistent across hospitals," says William Cioffi, MD, surgeon-in-chief at Rhode Island Hospital.
The Hospital Association of Rhode Island says it’s the first state to have all surgical providers voluntarily accept a standardized safety protocol. Hospital and healthcare leaders in the state worked with the Joint Commission to develop the new rules over the past 18 months. Some key features:
Three-way pre-op consult. The surgeon, 1 other licensed practitioner (such as an RN) and the patient or patient’s guardian all confirm the surgical site together before it is marked with the surgeon’s initials.
OR team briefing. All team members introduce themselves and their roles. The surgeon then briefs the team, identifying the patient, procedure and site, and explaining plans for the surgery, including any medications, documentation and equipment needed.
Time out. Led by the surgeon, all team members verify the patient, procedure and site and confirm that the site marking is visible after prepping and draping.
Post-op de-briefing. The surgeon leads a discussion of the post-operative plan of care and a review of how the surgery went and what could have been done differently.
Mark Crafton, Joint Commission executive director for state and external relations, says getting doctors and nurses to follow the new safety protocol will be "another challenge" facilities "will have to work on." He said the Joint Commission will work with facilities to incorporate the new rules and checklists into their procedures.
—Irene Tsikitas
