Archive July 2017 XVIII, No. 7

How Safe Are Your Patients in 2017?

Challenges remain, but many surgical leaders are finding ways to overcome them.

Jim Burger

Jim Burger, Senior Editor


encourage OR staff to speak up SEE SOMETHING, SAY SOMETHING Only about one-third of survey respondents say physicians always encourage OR staff to speak up if they have concerns.

Maybe the best way to get physicians to fully engage in surgical time outs is to turn up the volume. Literally. At one Texas facility, "the procedure doesn't start until a loud time out with all staff fully engaged takes place," says an assistant nurse manager. "Our physicians are totally engaged with our time outs [because] the question is asked loudly: 'Does everybody agree?'"

Why not belt it out, if that's what it takes? After all, virtually everybody in health care agrees that patient safety is — or at least should be — paramount. Our latest reader survey underscores the dedication and tireless work facility leaders are putting in toward keeping their patients safe. But the challenges they continue to face also come through loudly and clearly.

A failure to engage in time outs is one of the pain points, as are time pressures, communication and, most disconcertingly, an observed willingness on the part of staff and physicians to at least occasionally take shortcuts that could affect safety. Here's some of what respondents had to say.

When it comes to time outs, only 73% of our nearly 400 respondents say they can always count on full engagement from OR staff. A common theme pops up again and again. "It's difficult to engage the surgeons," says a director of surgical services from Oklahoma. "I sometimes feel that the surgeon is not paying attention," adds a clinical director from a Texas surgery center. "We complete a full time out," says a suburban New York administrator, "but at times we feel surgeons are not paying 100% attention."

Surgeons undoubtedly would like proof that time outs do more than just waste their valuable time. But to convince them, you may have to rely on a different tact.

Elizabeth Hall-Findlay, MD, FRCSC, a plastic surgeon and the medical director of Banff Plastic Surgery in Alberta, Canada, says insisting on a fully engaged time out comes down to common sense. "I just do not understand why surgeons resist," she says. "I was criticized [by other physicians] at a meeting once for not limiting the time out, but when we do them at our facility, we actually cover more than the patient, site and side."

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