Posted: October 27th, 2023

How to Enhance Safety in Operating Rooms

How to Enhance Safety in Operating Rooms

Operating rooms (ORs) are complex and dynamic environments where surgical teams perform various procedures that can affect the lives and well-being of patients. However, ORs are also prone to errors and adverse events that can compromise patient safety and quality of care. According to a systematic review, the incidence of preventable adverse events in surgery ranges from 3% to 22%, and the mortality rate is estimated at 0.4% to 0.8%.1 Therefore, enhancing safety in ORs is a crucial goal for health care organizations and professionals.

Some of the common factors that contribute to patient safety risks in ORs include poor communication, lack of teamwork, inadequate preparation, equipment failures, human factors, and disruptive behavior.2 To address these challenges, several strategies and interventions have been proposed and implemented in different settings, such as system engineering, collaboration, and checklists.

System engineering is the application of scientific and engineering principles to design, optimize, and evaluate complex systems, such as ORs.3 System engineering can help improve safety in ORs by identifying potential hazards, analyzing workflows, standardizing processes, implementing technology, and evaluating outcomes. For example, computerized medical records and barcoding of drugs and blood products can reduce errors and enhance efficiency in ORs.4 Moreover, system engineering can help design ergonomic and user-friendly ORs that minimize physical and cognitive workload for surgical teams.5

Collaboration is the process of working together toward a common goal, such as delivering safe and high-quality care to patients.6 Collaboration can enhance safety in ORs by fostering a culture of mutual respect, trust, and accountability among surgical team members. Collaboration can also facilitate effective communication, coordination, and problem-solving in ORs. One way to promote collaboration in ORs is through team training programs that teach skills such as leadership, situation monitoring, mutual support, and communication. For example, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a standardized curriculum that has been shown to improve teamwork and patient outcomes in ORs.7 Another way to foster collaboration in ORs is through preoperative and postoperative briefing and debriefing sessions that allow surgical teams to share information, clarify expectations, review performance, and identify areas for improvement.8

Checklists are tools that provide a structured and standardized way of performing tasks or verifying information in ORs.9 Checklists can enhance safety in ORs by reducing errors of omission or commission, improving compliance with best practices, and enhancing communication among surgical team members. For example, the World Health Organization (WHO) Surgical Safety Checklist is a widely used tool that covers three critical phases of surgery: before induction of anesthesia (sign in), before skin incision (time out), and before the patient leaves the OR (sign out). The WHO Surgical Safety Checklist has been shown to reduce mortality and morbidity rates in surgery by up to 47%.10 Furthermore, checklists can be customized to specific procedures or settings to address local needs and preferences.11

In conclusion, safety in ORs is a multifaceted issue that requires a comprehensive and multidisciplinary approach. System engineering, collaboration, and checklists are some of the key strategies that can help enhance safety in ORs by addressing the common factors that contribute to patient safety risks. By implementing these strategies, health care organizations and professionals can improve the quality of care and outcomes for surgical patients.

References
1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009;361(14):1368-1375.
2. Wahr JA. Operating room hazards and approaches to improve patient safety. UpToDate 2023; https://www-uptodate-com.proxy.library.uu.nl/contents/operating-room-hazards-and-approaches-to-improve-patient-safety?search=operating%20room%20hazards&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
3. Carayon P, Hundt AS, Karsh BT et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care 2006;15 Suppl 1:i50-i58.
4. Patient Safety in the Operating Room: Team Care | ACS About ACS Statements Patient Safety in the Oper… Statements Statement on Patient Safety in the Operating Room: Team Care June 1 2018; https://www.facs.org/about-acs/statements/patient-safety-in-the-operating-room/.
5. Joseph A, Bayramzadeh S. An overview of evidence-based design for healthcare facilities: a case for the operating room. HERD 2017;10(2):61-71.
6. Salas E, Sims DE, Burke CS. Is there a “big five” in teamwork? Small Group Res 2005;36(5):555-599.
7. Neily J, Mills PD, Young-Xu Y et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010;304(15):1693-1700.
8. Lingard L, Regehr G, Orser B et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg 2008;143(1):12-17.
9. Gawande A. The Checklist Manifesto: How to Get Things Right. New York: Metropolitan Books; 2009.
10. Haynes AB, Weiser TG, Berry WR et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360(5):491-499.
11. Russ S, Rout S, Sevdalis N et al. Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg 2013;258(6):856-871.

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