Day 1 of AELPS2018: Wonderful, honest, and compassionate discussions today about open communications, premature conclusions, and diagnostic error. I greatly appreciated the personal stories that were shared and the focus on improving communication across a healthcare team, including the patient and family members.
One area that struck me today was a case study about a missing sponge in the operating room and two different scenarios depending upon whether the team continued to look for the item, or if members of the team were unable to speak up and advocate for the patient. Although I agree that this is an area of great concern and focus, it seemed like the conclusion was to change the ability to communicate, but ultimately neither option appeared correct. Yes, overriding protocol and leaving the operating room with an incorrect count is not the best answer, holding the case and leaving the patient in the operating room under anesthesia is also doing harm. And I would argue that both of these are reactionary and the better option is to prevent this scenario in the first place.
We have come a long way by reviewing key aspects of cases at the pre-operative time out, but many times the nursing, anesthesia, and surgical teams are not aware of the case progress. Similar to policies that minimize nursing disruptions during medication administration, there are critical moments in operations when all team members should be focused on the patient. Distractions could include documenting non-urgent information in the chart, leaving the room to gather other supplies, or changing shifts. Systematically, the operating room should have a shared vision of the case, recognize the responsibilities and roles of all team members, and collectively decide on how to prepare and respond at critical times. To me, the responsibility of a correct count is everyone’s responsibility. The scrub and circulating nurses are physically counting, but the surgeons should be reporting when laps are placed inside the patient and when they come out. The surgeons should also wait to start the case until all equipment is present, as well as make space and time for the nurses to perform safe counts.
Staff in the operating room, like the ICU, the ER, or any other patient care area, have dedicated jobs and roles in caring for the patient. While this division of labor is necessary, all of us can put patient care first by ensuring our coworkers can efficiently and safely complete their individual jobs.