Colonoscopy is indisputably the gold standard for colorectal cancer screening, but a recent study speculates that it may be overused among older patient populations.

For a study published online by JAMA Internal Medicine this week, researchers at the University of Texas Medical Branch in Galveston reviewed the state's Medicare claims, along with a sample of nationwide Medicare claims, for colonoscopies in 2008 and 2009.

According to their analysis of the data, 23.4% of the colonoscopies performed on patients 70 years of age or older might not have been necessary. This was either because the patients' previous screenings returned negative results, or because they weren't yet due for a follow-up screening.

"Inappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively," write the authors.

David Bernard

A Canadian ophthalmologist who sang while implanting a lens in a patient's eye has been cleared of wrongdoing, but he didn't escape an admonishment from the College of Physicians and Surgeons of British Columbia for his unprofessional behavior.

A patient complained about the surgeon's singing in a letter to the College 10 days after a May 2012 surgery. The patient also alleged the surgeon said he planned on using leftover hospital towels to "wash his car" after the procedure. In the letter, the patient called the surgeon's actions "unacceptable, arrogant, disrespectful and shameful."

"We don't have specific rules about singing in the OR, but physicians should certainly be mindful of their actions and words during any procedure," says Susan Prins, the college's director of communications in a statement. "Professionalism is always expected in any patient-physician interaction."

The patient, unsatisfied with the dismissal of his complaint, appealed to the British Columbia Health Professions Review Board, which upheld the college's decision. Documents show the review board acknowledged the issue was of "extreme importance" to the patient, but there was "no serious misconduct" by the surgeon that needed to be dealt with or received inappropriate attention from the College.

It's not the first time the behavior of a Canadian eye doc has drawn the college's attention. In 2011, it sent out a gentle reminder to members to keep "idle chatter" to a minimum during surgery after a patient complained that a surgical team discussed the outcome of a hockey game throughout a procedure, which made the patient feel uncomfortable and concerned that the surgeon and staff weren't focused on the task at hand.

Daniel Cook

Errors that result in patient harm can be as simple as this: A patient has a PCA pump and a continuous nerve block pump, side by side. An anesthesia provider identifies the nerve block pump and tubing to administer a bolus. But then he's momentarily distracted. When he returns, he doesn't re-identify the nerve block pump and accidentally programs the PCA pump for the bolus. The patient ends up requiring a naloxone rescue.

That's just one real-life example from a recent report by the Pennsylvania Patient Safety Authority, which has analyzed 1,015 incident reports attributable to distraction. The majority resulted in medication errors (59.6%), followed by errors related to procedures, treatments, or tests (27.8%). Thirteen of the reported events resulted in patient harm. The article examines root causes, such as distractions due to technology or face-to-face interaction. Even communication of relevant patient information can cause distractions that lead to incidents, it notes.

The PSPA report offers over a dozen strategies for minimizing the impact of distractions, including avoiding small talk when performing safety-critical tasks (such as the preoperative time-out), using checklists for complex or multi-step tasks, and implementing communication strategies that do not involve oral communication. "Multitasking is frequently the culprit in these patient safety events," says the PSPA. "In some cases, multitasking increases efficiency by eliminating downtime. But in many more cases, efficiency is decreased because of the limited ability of the human brain to process more than one task at the same time."

The 5th annual OR Excellence Conference, taking place Oct. 23 to 25 at the Red Rock Resort & Spa in Las Vegas, Nev., will include an expert talk on dealing with OR distractions.

Stephanie Wasek

A growing body of evidence supports the clinical benefits of maintaining normothermia throughout the patient's surgical experience, starting in the pre-operative phase and continuing through to discharge. Tell us in this week's InstaPoll if you pre-warm patients at risk of unplanned hypothermia before the induction of anesthesia.

Last week's poll showed that most (85%) OR staff members feel comfortable speaking up when they have safety concerns. The results, based on 325 responses:

• Strongly agree: 64%
• Agree somewhat: 21%
• Neither agree nor disagree: 3%
• Disagree somewhat: 10%
• Strongly disagree: 2%

Dan O'Connor

• Do BSNs save lives? Can hiring more nurses with 4-year degrees cut patient mortality? A recent study conducted at the University of Pennsylvania's School of Nursing and published in the March issue of the journal Health Affairs correlated a reduction in surgical patient deaths at 134 hospitals to an increase in the number of BSNs on staff. While 45% of American nurses currently hold the degree, the Institute of Medicine recommends that percentage rise to 80% by 2020.
• Georgia won't repeal CONs A proposal to repeal Georgia's single-specialty certificate of need exemption, which would have let multi-specialty centers forgo the CON process, has died in a legislative committee, according to a news report. The Health and Human Services Committee failure to pass HB 279 on to the state's House of Representatives rendered the issue null for this year.
• Spine's SSI risk factors Thick subcutaneous fat and higher ratios of total distance from the vertebrae arch to the skin surface at the surgical site increase surgical site infection risks after posterior cervical spine fusion, according to a study in the Journal of Bone & Joint Surgery. A review of 213 patients who underwent surgery between 2006 and 2008 at Duke University Medical Center revealed that patients who developed SSIs had an average of 27mm of subcutaneous fat compared to 21.4mm in patients who did not. Additionally, patients who developed infections had fat-thickness-to-total-fat-thickness ratios of 0.42, compared to ratios of 0.35 in patients who remained infection-free.