In Brief

Article Outline

• Copyright

Safety issues have always attracted surgeons’ attention, but the details have frequently been left to nurses, and more recently to anesthesiologists. Surgeons have always assumed patient safety was a primary goal; however, recent findings and regulations from the Joint Commission for Accreditation of Hospitals (JCAHO) and Occupational Safety and Health Administration (OSHA) have challenged this belief. Only recently has academic surgery addressed the issue of error prevention and causation. It will be the purpose of this monograph to address the specific safety issues of retained surgical items, wrong site surgery, and injuries from sharp instruments, all of which affect the practicing surgeons in the operating room.

The word safety is defined as a state of being safe; freedom from occurrence or risk of injury, danger, or loss. Error, on the other hand, is a deviation from accuracy or correctness—a mistake. Practicing error prevention attempts to lower the possibilities for human error to a minimum. The airline industry, held up as the safest, finds accident rates of 1 per 243,309 takeoffs and a rate for near misses of 1 per 166,583. By comparison, a defect in performance has been reported in 1 per 2.22 patient encounters.

The idea that doctors are not only responsible for safety but can contribute to errors has been a difficult concept for medical practitioners to accept. Lister’s theory of germs and antisepsis was not embraced, and Semelweiss ended up in an asylum when he proposed his idea that surgeons were carrying puerperal fever from patient to patient by not washing their hands. The concept that the surgeon could actually be causing the problem was anathema. When Codman suggested that surgeons should examine their results and publish them, the Boston Medical Society and the Massachusetts General Hospital rejected him and caused him to establish his own hospital.

It is consistent with this history that surgeons feel that the “count” that nurses perform during their cases are an impediment to their surgical efficiency, and that the surgeon is not responsible for this menial task. The recent emphasis on “time out” and “boarding passes” to identify a patient verbally and visually, and identify the operative site and side, has not been embraced by the surgical community. The use of double gloving, safety needles, and scalpels and using a hands-free technique have been difficult to place into the operating room (OR) arena.

We as a profession are realizing that although mistakes happen, we may be able to minimize many errors in the OR and make the OR a safer place for patients, staff, and surgeons. The authors hope that this monograph will help surgeons to work in the safest environment possible. We encourage them to accept their personal responsibilities, not only to perform a flawless operation or procedure, but also to participate in the team effort to protect patients, other healthcare personnel, and themselves from harm. A “sea change” in surgical philosophy is necessary to minimize the retention of foreign objects, and to maximize the safety of all involved in the procedure. This means an attitude shift to the acceptance of rules and regulations as a protective strategy.